A Place to Die

by Dr K L Choudhury

Cancer is a horrific disease; terminal cancer is death waiting in the shadows. Waiting, yet in no hurry to pounce on its victim and gobble it up. It goes about its work leisurely and kills at its own pleasure. Like the wily cat does with the mouse, catching it in its paws only to let go for a while, tantalizing and terrorizing, turning and twisting , throwing up and dashing down, enough to mesmerize and paralyze but not hard enough to kill. By then the victim is prostrate and helpless, begging mercy, waiting for release that comes only when death is ready to embrace him and not the other way round.

I knew Omkar Nath from the time he came to me in 1975 with his pretty little daughter, Nimmi, who was suffering from pleural tuberculosis. That was nearly two and half decades back. Subsequently he got his son, Dileep, to me whom I diagnosed rheumatic heart disease; and then his wife, who suffered from a duodenal ulcer. Since then I was their family physician and friend till the times when the happy valley was overtaken by a cataclysm that bruised and sundered human relationships and drove hundreds of thousands into exile.

Omkar Nath landed in Jammu in the first wave of exodus in the winter of 1989-90. He was one of the estimated three hundred and fifty thousand Pandits who were hounded out in the terror that took the valley of Kashmir in its deathly grip. Exodus scattered the Pandits like people in a shipwreck. Some where drowned in the first storm of violence, others found rafts that carried them to far off lands, yet others are still floating in the choppy sea trying to come ashore.

Within a few weeks of his arrival in Jammu, Omkar Nath took ill and his family found itself miserably alone and helpless. They had lost contact with most of their relatives and friends. They looked for me but did not know that I was still in Srinagar. Much later, in May 1990, I moved to Delhi spending eight trying months there before I migrated to Jammu. By that time he had been going from one doctor to another, not knowing anyone in the host city.

Soon after I settled down in Jammu, word went round in the refugee camps, and patients started pouring in. The family finally found me out and brought him to my rented lodgings at New Plots.

Omkar Nath had never been ill since I knew him. He was always sparsely built, lean, and sallow complexioned. But now I could barely recognize him. He was run down and had acquired a darker tan, partly from the sun and partly from disease. He stooped with pain, his eyes proptosed with fear and he looked a shadow of his old self - a distorted, dwarfed shadow. He wore an unmistakable cancer visage. By the time I heard his story the visage grew larger and when I finished with his examination it became more real than life. He had already developed metastasis in his liver. It was the beginning of the end.

Without much ado I divulged the prognosis to his rheumatic-heart-afflicted son, Dileep. By now he had exploited all his reserves of energy and financial resources and, though the revelation that his father would not last long came as a shock, he could not hide a sense of relief. Sometimes relief from knowledge of the worst is better than the torture of suspense. Now he was free to organize the ritual of terminal care without having to run after doctors and subjecting him to unending lab tests, ultrasounds and x-rays.

Our plan was to make the patient as much pain free as possible and let him die in peace. But peace has so many variables like a complex equation. There is the outer peace that comes from outside influences; in this case, the place one lives in, the attitude of care givers, the attending doctors, and visitors. And there is the inner peace which is hard to define and harder to attain. How was peace to come to one suffering from the grinding pain of terminal cancer, condemned to exile, without a roof on his head, and no place to die?

When his condition deteriorated and his relatives came to learn of his illness they started pouring in. Most of them were refugees who had fled Kashmir like him and had little else to do except to search for their lost tribes and to exchange notes of the travails they had to go through the elaborate formalities to register as ‘migrants’ with the relief authorities, scouring for shelter, finding schools for their children, hunting jobs for themselves, establishing new contacts, striking new roots. The least they could do was to visit each other, and share their cups of sorrow.

The landlord was unhappy when he estimated the number of people visiting his sick tenant everyday from the number of footwear that they would take off outside the room he had rented out to Omkar Nath and his family of four - his wife, son and a daughter. He did not like crowds in his already cramped house. The common corridor to his own rooms and to the room he had rented out to the family, and the only restroom for his own use as well as for his tenants, could not accommodate the additional traffic of numerous visitors. The place was getting choked. He gave them notice of one month to find alternative accommodation.

The family could not stop visitors; that was not done in our part of the world. We do not shut our doors to monks, mendicants or mongrels; there is no question shutting it to relatives, friends and well wishers. But the landlord saw no logic in this argument and asked them to quit. They offered higher rent. No, he had made up his mind.

Dileep went from door to door to find a place but there was no available space. The family had found the present accommodation in Sarwal without any difficulty, being amongst the early ‘migrants’. Now, Jammu was bursting at the seams with the refugee avalanche from Kashmir that settled itself at all conceivable space in houses, stables, cellars, store rooms, dungeons. The rents had hit the roof and were touching the sky. The tents provided by the administration were all taken. Some old and dilapidated buildings were thrown open to accommodate the rush. Those who found no place in Jammu moved on to neighboring towns - Samba, Kathua, Kistawar, Doda, Kud, Batote. Many others filtered to Punjab, Himachal and Haryana. A lot more moved to Delhi and the rest to other metropolis. The scatter became wide in no time as the exodus from Kashmir caught momentum parallel with the escalation of violence and terror.

As the deadline drew to a close and frustration mounted, Dileep met an old friend by chance who knew of a family with a spare room and asked him to have a look. It was an ill-ventilated room in a dilapidated house in the innermost recesses of the old city accessed through narrow lanes where pedestrians had to squeeze themselves to avoid brushing against each other. But beggars cannot be choosers. Dileep hoped his family would somehow tide over the stormy end in this bleak retreat.

That was a false hope, though. It was literally moving from the frying pan into fire. Omkar Nath deteriorated rapidly. He became claustrophobic in this dark, damp room. The plaster was peeling off the walls, sculpting monstrous shapes that took the visage of Yama and frightened him. A small window in a wrought iron frame looked out at the dingy lane outside, bringing in stench from the drains. He asked them to keep it shut. But summer made it hotter inside. The fan, the only means available to beat the heat, made it worse, for it blew gusts of hot air on his already febrile frame.

Were these the burning fires of hell that he had heard about? How long had he to go through the agony before the end came? Was he really dying? His thoughts often wandered to his past. Back home, he had lived from hand to mouth right from his childhood, yet always in contentment. His father had left him a modest dwelling and a small front yard with a solitary pomegranate tree and a flower bed where he planted marigolds for his gods. He offered them fresh when they bloomed and dried the reminder for winter use. There was a rose bush near the porch which he doted upon like his own children. He had worked hard to provide education for his son and daughter. But there was still unfinished family responsibility that plagued his troubled soul. Dileep, an agricultural graduate was jobless, and Nimmy, a commerce student, without a trousseau, yet to be married off. What tortured him most was the thought of his wife, much younger than him, donning the mantle of widowhood. He wanted to go back to Kashmir and die there in his ancestral home. And he repeated his wish every day to his family: “It is better to face the bullets in Kashmir than the living hell here.”

The pain grew and Omkar Nath groaned day and night. Painkillers that I prescribed did not seem to work. Pethidine, morphine and other narcotic drugs were banned from sale because the city youth would lap them up from the pharmacies before it reached the deserving patients. The substance abusers resorted to cough mixtures with codeine as an ingredient. That too was banned. I was left with no choice except to prescribe heavy doses of sedatives and available pain killers, with little effect. The pain came in fits and spasms and he whined like a bitten dog, rousing the whole neighborhood. His anguished cries tore the stillness of night and it was not long before the landlord complained to the family.

“Your patient is howling all the time. Pray who is treating him?”

He was told that their patient was in the best hands, but he was not impressed with my name.

“I have never heard of him. Why don’t you go and get a local specialist. Your patient may be suffering from some regional affliction which your doctor has not come across so far. The ‘migrant’ doctors will take time before they get acquainted with the problems specific to this place. I would suggest you get Doctor Gandotra; he is the best in town.”

Dileep had no choice but to keep his landlord in good humor. He found the doctor’s address and brought him to see his father. The patient was not happy with a doctor whom he did not know, with whom he could neither communicate freely in his own language nor strike a wavelength that is so vital in healing. But he was asked to bear with this arrangement. The doctor ordered some more tests and prescribed a different set of medicines.

Dileep rushed to me with the new prescription asking me what he was to do. Normally I leave it to the choice of the patient and his attendants to exercise their own discretion if they invite more opinions on a patient under my care. But this was no time to take offence. Here was this desperate young man having to make all decisions at a tender age and me as his only hope. The family was left with scarce resource for the luxury of unnecessary tests and cancer medication which would be, in my opinion, futile at best and painful at worst. Medical ethics does not justify meddling with a dying patient, or trying questionable remedies without his consent. Death, when its time has come, should be welcome. In trying to prolong life in such irredeemable situations, we might make it more insufferable. Therefore, it was alright to have brought the doctor home to satisfy the whim of the landlord but that is where the farce should stop.

Omkar Nath was wasting away fast. Days and nights merged into each other in a miasma of nausea, retching, pain, and passing out from sheer exhaustion. He developed jaundice from cancer invasion into the bile channels and his complexion took an eerie hue of black and yellow. The landlord sensed the specter of death in the room. The doctor he had recommended had failed. It made him uncomfortable as the specter grew bigger every day threatening to shroud his own dwelling. He did not like the idea of his tenant dying in his house. He had learned of the elaborate Kashmiri Pandit rituals of death and the post funeral rituals extending beyond the days of mourning into the 10th day ceremony with all the relatives and friends gathered at the river ghat while the bereaved son goes through a tonsure and a clean shave, a dip in the water, and the immersion of rice balls and earthen pots, followed by three days of more elaborate yajnas - mini shraddhas -

that steer the deceased through his arduous journey in the world beyond and ensures a place in heaven. The fortnightly, monthly, six-monthly and yearly ceremonies would follow with unfailing regularity. No, he would not allow any of this in his house.

“Mr. Dileep, your father is getting worse every day. You will have to do something about it,” the landlord called him aside.

“I know. We tried everything, including the doctor you suggested, and even phanda, your local voodoo, at the behest of your wife.”

“But he is dying, can’t you see?”

“Yes, he is deteriorating fast. My mother keeps hoping but the doctors do not give him much of a chance.”

“You will have to quit before the time comes.”

“That cannot be. Where will we go with a dying man? You have been kind to let us your room; please bear with us a little longer.”

“I will not allow any mishap in my house. You must move before it is too late.”

“Give me a few days and I will start looking for room elsewhere.”

“Do it right away, before you find your belongings on the street.”

Dileep was on the hunt again for alternative lodgings. He sounded his relatives and friends; he went from door to door in the immediate neighborhood and in far away suburbs but drew a blank everywhere. The landlord visited his father every evening, saw death closing in, and repeated his threats. Dileep dared not show him his face and returned home much after the landlord had gone to bed.

Omkarnath lapsed into a twilight state alternating between drowsiness and light wakefulness. His son came rushing to me.

“Doctor, my father is sinking and the landlord wants us out before he attains nirvana. Please do something, try some miracle to keep him alive a little longer till I find a place for him to die. Please doctor, some glucose infusions, some untried remedy that sustains life a little longer.”

It was heart-wrenching. I had watched this young man grow from a kid, carrying the burden of an enlarged heart, and a larger family responsibility. I did not know how to help him but an idea flashed in my mind.

“Why don’t you give an ad in the paper? After all, there may be someone out there who has room to spare.”

“But we will have to keep quiet about my father’s illness. Who will let us room with the knowledge that we will be moving with a dying person?” he asked.

I scribbled on a piece of paper and handed it over to him. The ad appeared next day in the local newspaper.

Wanted: A Place to Die.

A family of four, one of them sick and dying, in desperate need of lodgings.

Size of accommodation and rent no consideration; just enough space to die.

I gave my phone for contact because the family did not own a phone.

When all hope is lost, there is hope lurking somewhere in the least expected place like a beautiful flower behind a boulder in a remote corner of the garden.

Sardar Gurbax Singh of Nanak Nagar phoned me the same evening. He had two rooms to let, would I care to have a look.

I sent for Dileep and directed him to the address. “Whatever the rent go ahead and clinch the deal,” I urged him.

Gurbax Singh was a jovial Sikh, the kindness of his heart matching the span of his moustache which he twirled after every sentence he spoke. He invited Dileep to a cup of tea before he showed him two well ventilated, lightly painted and furnished rooms. Dileep would not believe his eyes. The ideal place to live, he thought to himself; and to die.

He inquired about the rent.

“Who is bothered about the rent, young man? Pay whatever you think is right, and when you have the money. No advance, no security. And, no rent for the duration your father is alive. This is a matter of life and death and monetary transactions are unbecoming.”

Then, patting his back lightly, “I liked your frankness in the advertisement. Now, why did you have to mention about it?”

“My doctor wrote the ad for me. I hesitated for sometime before I gave it to the newspaper. He was right; I would not be able to face you if I carried a dying man into your house without your knowledge. You could deny us entry and we would be on the road. We have been turned out once and my present landlord is waiting hammer and tongs to knock us out of his house. Death is the last visitor anyone would want to ever see in one’s house.”

“And, yet, that is the very reason I lost no time in making contact. My rooms have been lying vacant for a long time and I had no idea to rent them out. I would do so only in very special circumstances. Well, my home is here to welcome death, if that is what you are bringing along with you. Everyone has to die one day, some sooner than later.” He twirled his moustache harder and let off a long sneeze as if in attestation of what he said.

“Go get your family, the dinner is on me tomorrow when you move in.”

Was it real or was he having a pleasant reverie? Dileep pinched his skin hard in his thigh from within the pockets of his trousers and almost gave a startle. He shook the Sardar’s hand so hard that his own started to ache and tears of gratitude rolled down his cheeks. He ran out of the house almost delirious with joy that his dear father would not die on the road but in the very congenial environs of an extraordinary man. He cried aloud, to the amazement of the passersby, “Jo bole so nihal, sat saria akal!”

Reaching home in that fit of excitement, Dileep rushed to his dying father and gently shook him out of stupor.

“We are returning home tomorrow,” he spoke near his ear.

Omkar Nath opened his eyes lightly, looked at his son in bewilderment, and closed them again as he started mumbling, “Home, home…” and relapsed into stupor.

Next day the family moved to Nanak Nagar and, first time in many days, stretched their limbs that had become cramped in a hell hole. It was after they settled in the rooms that Dileep’s mother threw open a window and saw a pomegranate tree in its second bloom in the front garden. She asked her son to seat his father in a chair and bring it near the window.

“We are home. That is your pomegranate tree. Look at the red flowers in bloom,” she pointed to the tree.

Omkar Nath opened his eyes wide, looked out, and held his right arm out to reach the tree. He touched a flower gently - the familiar inflorescence - smooth shiny tubular base with vermilion petals at the top. A strange light shone in his eyes and a flicker of a smile on his lips before he passed out again and was helped to the bed. On his dark and yellow face, now assuming a light vermilion hue like the flower he touched, there was deep contentment, the same that he had worn as a motif of his plain living all his life.

The following day, the lord of lords, deciding finally to embrace Omkar Nath, made the formal visitation and took his spirit away with reverence and care, to the chants of Om Nama Shivae and Sat saria akal as his head lay on the thigh of his son and the family helped him to the last mortal drink of holy water from the Ganges.

Peace prevailed in death.

The beneficent Sikh arranged everything that goes with the cremation and on the morrow he vacated the ground floor where he lived with his wife and went to his brother’s place for the next fortnight so that the tenets would observe the rituals without any let or hinder.

A Space to Die

‘Your father is sinking day by day.
Why don’t you change your doctor, say?
The refugee medics will take their time
to grasp the afflictions of this clime.
A phanda may help, or a mantra,
till you seek out Dr Gandotra.’
I had no choice but soon to call
the celebrated physician before nightfall
but father grew from bad to worse,
enfeebled, stuporous unable to nurse.

‘If all the measures fail to revive,
your patient may not long survive.
In view of his critical state
you better move before it’s too late.
I can allow a few days grace
till you find another place,
but no mishaps here in my residence,
no mourning, no impertinence.’

I rushed back to my own doctor
as the condition deteriorated from hour to hour.
‘Pray prolong his life a few days
till I shift to an alternate place.
Some shots, some freak remedies,
a little breather, a slender lease.’

Off I went from door to door
to rent a space just five by four,
where father may rest in peace awhile
ere Yama takes him from exile,
to where he wishes for ever to lie
in his native place, so glad to die.

From: “Of Gods, Men and Militants”
K L Chowdhury