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  • Writer's pictureDr Chitra Pandya

MY EXPERIENCES IN PALLIATIVE CARE: THE MOST HUMANE FACE OF A NOBLE PROFESSION (Part 2 of 2)

While walking through the village facilitating the house-to-house palliative care survey being done by the medical students, I had specifically taken note of two homes, which I later visited independently. Those are the visuals that refuse to leave my thoughts even today. As I walked into a narrow lane, I saw a man (henceforth referred to as Dadaji), frail and bent with age, standing facing the wall, with the support of a khatiya (bed) propped against the wall. I did not give it much thought, “Probably he is doing some routine work in that corner.” I greeted Dadaji and his wife (henceforth referred to as Baa), and requested them to sit with me for a few minutes so I could assess the palliative care need of the household. Dadaji did not move. After a few minutes, I requested again…Now a little curious as to why he would not move. On directly questioning Baa if things were ok with Dadaji, I was appalled to hear that he had painful hemorrhoids since more than a month, which had worsened in the last week, and he had not sat down or slept for SEVEN whole days and nights. My brain refused to believe the story, and thought of it as an exaggeration. But the young granddaughter, getting ready for school, reiterated that he had been standing this way for 6 days now! I froze. I did not know what to do. I gathered myself gradually. Without any equipment, not even a pair of surgical gloves, I decided to examine the patient. I helped Dadaji lie flat on his abdomen, and with his consent, Baa and I removed his clothes, soiled with urine and feces. Other family members stood and stared. With a wet cloth, I cleaned the perineum, and examined the hemorrhoids. I was then informed that a doctor they had consulted had given them a prescription, but they had not been applying the ointment, as they did not know how to do so. Two expensive tubes were lying around the house, unused. As per the family, any more visits to the hospital were not possible due to various reasons. I knew I had to do the best possible in the given circumstances with limited resources at hand. With no packet insert to be found, I called up a friend who was a surgical resident, who explained the procedure of application to me. Now confident, I demonstrated the ointment application process, thoroughly explaining the steps. I also encouraged Baa and the young granddaughter to show me how they would apply the ointment to Dadaji. Having finished this, I sat the family down, and counselled them in my capacity regarding the issue at hand. I left the home, dazed. I visited the home again next week, and saw Dadaji resting, still frail, but at least able to lie down and rest. Unsure if he would be taken care of in the days to come, I visited the Primary Health Centre, spoke to the designated grass root health worker about the patient. They took details and reassured me that they would follow up. At the time, I had decided I would follow-up myself to know if he was being adequately cared for, but I could never visit the place again. Residency continued and so did my life.

The other home I visited independently was definitely a home, but was by no means a house. It was four walls, and a floor. The roof was formed by metal sheets in half and was open to sky in the other half. A thin, wasted man sat in one corner, with a pile of old clothes plopped onto a broken bed and a few vessels strewn on the floor. But when I turned to look at the other side, I saw a shelf made of mud and brick, clean…with frames of Gods and Goddesses adorning it and a lady’s photo placed carefully in the middle. It was his wife. She had died a few months ago from unknown causes. The couple had no children. His nephews lived in the houses adjacent to this house and gave the old man food and water to live. I asked but was not told what sanitation provision he had. He greeted me with a warm smile and would not stop talking for 20 minutes! He reminisced about his wife and their life together. After her death, he shared that he sold the metal sheets of his roof to earn some money for sustenance. He was malnourished and cachexic. He was starving. I spoke to his nephews and their wives, with little response from them. Again, I was lost and did not know what to do. I gave him whatever money I had, knowing that it was not the solution. I just spent some more time talking to him. He said he had no one to talk to anymore. When I left that day, I decided I would try to mobilize some help for him in his community. When I returned for my next visit, with some plans to mobilize help with support of some interested undergrad medical students, we visited the home to find it open and empty, with the belongings still lying there. I asked the neighbor where “Dada” was. I was told he passed away a few days back.




Image 1: Starving...For Food or Family?












Image 2: A corner of the home to preserve memories of his wife and his faith



















Image 3: The roof of his home...sold off for sustenance.

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