Nothing terminal about terminal illness

Dr Govind Hoskeri

O my soul, do not aspire to immortal life,
but exhaust the limits of the possible.
—Pindar, Pythian iii

Netherlands has become the first country to allow Cannabis Indica to be sold under prescription for the terminally-ill patients. This act of mercy from misery, in the land of mercy killing, needs to be seriously considered by other countries as well.

Terminal illness is an unkind word that pushes the patients suffering from the clutches of inhuman pain, to the brink of the end of the world, to a point of no return. The medical world, which generally is quite elusively efficient in coining words that sell hope, has failed to identify the meaning of this term that has the effects of a terminator, tormenting the patients, consciously or subconsciously... and even on a subtler plane than that.

The ruthlessness may not have been intended. But the worst has not been recognised. The amount of moral strength with which men and women fight the inevitable, should bring some sense into the medical world and make it a little more sensitive to the feelings of patients. You take them to a hospital, specialising in treating the terminally ill, something in them dies. That something, which they have been accumulating over the years to bear and to continue to live with the best of their own selves, goes haywire.

In the absence of useful treatment, we need, at least, to stop insulting the patients. What are we offering them? The whole spectrum of treatment modalities available is nothing but a statement of failure on the part of the scientific world even to understand the nature of the agony except for offering palliation and pain management in most of the cases.

If we cannot afford to quell the storm, we need not create a storm. The factual world of medicine has to come out with a better word, at least, instead of scything them with the unkindest cut of all...reminding them of the inevitable.

.A diabetic waiting for the blood glucose estimation...a heart patient trying to read the face of a doctor as the ECG is being recorded...a cancer patient trying to decipher what does it mean by a poorly differentiated carcinoma...the whole process of standing or sleeping in awkward positions for X -rays or going through the cold and tubular CAT and PET Scans or even colder Bone Scans...listening to the sounds that are too peculiar to comprehend...looking at the distorted images of their own selves on the computers. Even in these bone cold environs, one tends to sweat...reminding me of a classic work of poetry ever written in Indian literature, which perhaps is unparalleled in the world literature too.

Duryodhana at the fag end of Mahabharata war escapes and hides himself from the death-hunt in the form of Bheema following him with a huge war cry. Kumaravyasa, the 15th century poet, is an exponent in the art of usage of metaphors, known as rupakalankara in Indian poetics, writes that although Duryodhana is submerged in a pond of water, starts sweating from every pour, at the prospect of meeting Bheema, in the fateful duel of mightiest of the mighty maces.

I remember an old lady, a village woman, who came to me in my early days of general practice. She had an abscess on her palm. My efforts at convincing her that the abscess needs to be incised and puss let out, fell on deaf ears. The word ‘operation’ frightened her and she opted for medical management...of no avail...she finally agreed for the surgical intervention.

There were no hand surgeons in those days. We used to operate upon such cases in our clinics. As soon as the incision was taken, the puss, which was held under such huge pressure, shot up and hit the ceiling of my clinic. Ceiling was high, really high and had nothing false about it. The only person who had problem was my helper cum man Friday, who had to borrow a ladder to clean the ceiling with the antiseptic solution ‘to his satisfaction’.

As soon as the puss hit the ceiling, there was a deafening shriek... followed by a deadly silence...replaced by snoring, which was music to my ears. She was alive. I could afford to leave her alone to sleep. There was enough time for the next patient to step in. There may not be a next one, for the day. I let her sleep, a little anxious, with my fingers often trying to feel the pulse, to make sure that every thing was all right with the old heart and as well with my surgical adventure. She got up and unbelievable was the expression. There was no pain. She had not slept for days together.

This is what I mean by the relief that one feels after the diagnostic procedures of modern medicine culminate, hopefully, one day, that may get extended to a few days or few weeks together. Those many more days of those many more sleepless nights. Technological advances have been able to pick up the disease at a molecular level with the precision of a surgeons knife. And when the final incision (decision) is taken the puss collected, gets released to the point of hitting the ceiling; the person sleeps like the old woman, after so many days.

Days after days of running around the corridors of the hospitals and laboratories...these corridors can be as cold as the corridors of the Taj Mahal on a wintriest night, in the warmth of ones own niche, sleeps the indomitable spirit, with the tired bones clutching to the fractured dreams, only to wake up to the reality next day. The reality of no treatment of consequence...

When we can reach the cancer cells at the subatomic levels as in Positron Emission Topography, PET, is it possible to send ‘sugar coated medicines’ to reach and treat them? If no one has worked on these lines, it may be worth its while to do so. I do not even wish an acknowledgement of this idea, if it is going to help open a simpler and least costly approach to the treatment of cancer. I have always maintained that complicated problems have simpler solutions.

Till such time such a simple solution appears...the rains sharpen their edges over the pyramids of the Pharaohs in the arid deserts of Sahara, with a possible potion bottled and stored alongside them, to make them come alive, in as much as the ones surrounded by all the armor against cancer today. The hope never leaves even those termed terminally dead.

It is simply unimaginable to understand the nature of trauma that one goes through while carrying the load of ones own corpse, on ones own shoulders. This is a moment of a new beginning when life assumes much more meaningful dimensions. The purpose of living gets sharper. Such a process of positive evolution needs to be called by a life-sustaining name. Any thing less than that, is cruelty to this corpus of humanity.

We should stop calling this massive collective spirit that is embarrassing the deadly disease itself, by names like terminal illness...This is no absurd sensitivity. This is a tribute to the community that has been defying death and has been defining the limits of a helpless medical science to prove itself. There is nothing terminal about terminal illness. There shall not be...

The writer is associate professor, anatomy, Seth G S Medical College and KEM Hospital, Mumbai.

Email: hoskeri@rediffmail.com