Care of the Dying: What does it involve?

I landed at the Palliative Care Unit of Bangalore Baptist Hospital (BBH) early today morning with a lot of apprehension in my heart. I was to write a report on the counselling care offered to people under care of a hospice or hospital as a part of my assignment for the Counselling course I had just completed. Having learnt that BBH is one of the very few units offering such services, I took the necessary permissions and went over there.

The Urban Palliative Care Team consisting of a Doctor, two nurses and a chaplain, warmly welcomed me and off we went riding the vehicle donated by some grateful relative of a patient. The sweet little Doctor opened her small little tiffin box and started to eat her breakfast! The Pastor tried to mix philosophy with a lot of humor and I got used to the team.

The doctor tried to enlighten me with the history of Palliative care in Bangalore and the world in general and gave me a gentle introduction to the first patient we were about to visit. We climbed the stairs to visit the first patient. By the way, all the patients under palliative care are those who have received their death sentences, most of them being cancer patients, and are in various stages of progression of the disease.

The first patient was a woman of 42 years old, Kamala (all the patients’ names have been changed to keep up confidentiality) mother of two grown up children. She was sitting on her bed placed in the sitting room and looked remarkably well, cheerful, smart with a bright face and a nice smile and sparkling eyes. Is this the patient? I couldn’t believe.

Oh, yes, but a cheerful patient, who said her only prayer is she should be able to be in good health and cheer till the last moment. However, she admitted that her hope and enthusiasm vanished like a punctured balloon, when she felt the discomfort of her rectal cancer. Her clothes get dirty and smelly and her family members are washing it. She felt bad about it.

Her son has chosen to work from home to keep an eye on the mother. Her own mother comes over every day in the mornings to make keep her company and to make juices and other such liquid diets for her ailing daughter to be given once in two hours.

The palliative care unit went about their work in a very organized manner. The doctor checked the patient, checked the medicines she was taking, prescribed certain modifications and looked into the records. One nurse moved in and checked the blood pressure (BP); and having personally witnessed the son shouting at the mother while on conversation with the nurse on telephone when she was in the Unit, she went aside to talk softly to the son. The other nurse recorded things on the format.

Once the medical team finished with whatever they wanted to see, do or talk, then moved in the pastor. Kamala being a Hindu, the pastor asked permission from her and her family members present there to pray for her. They gladly agreed and the pastor prayed a sincere prayer for her well-being and health till the end. Then with good byes we all left, not before tasting the lovely coffee they offered to all of us!

I felt quite relieved; no great traumas as I had expected. This is going to be a cake-walk. A cheerful patient wanting only to be kept in such cheerful state till the end! Once in the vehicle, pastor and the doctor slowly brought it to light it was not all that cheerful. The lady obviously put up a show with tremendous effort to show a cheerful demeanor for her visitors. Now it was my turn to feel like a punctured balloon!

Next was an elderly gentleman, George, in his early sixties, again lying in his cot placed in the hall/sitting room of a nicely furnished home. The man was morose, dull and was obviously in pain over his abdominal cancer. There was no smile on his face, but a dull pain. The doctor-cum-nurse team quickly moved in and did all the routine check-up and discussion with the family members, the daughter and her husband.

The pastor moved in next; the others excepting me and one nurse went outside to talk to the family and the pastor had the man all to himself. Amazing, he sat next to the patient, took the patient’s hand in his hand, pressed it to his own chest, looked deeply into the eyes of the dying man, and conversed with him, ever so softly and gently. When asked later what really transpired, the pastor said, he had to do what he did, because of the question George had asked him.

George had asked the pastor, ‘so how much time do I have?’ The pastor almost asked him how much time he would want and went on to talk to him about the statement of the Apostle Paul, when he was awaiting his trial under the Roman authorities. He had said, ‘to live means to live in Christ and to die means to be with Christ.’ So either way, he was happy, because living or dead he would be with Christ.

The Pastor talked in his soft voice for quite some time to the patient, occasionally caressing his head, telling him in his faith, George has Christ living in him and if and when he dies, he need not worry because he will still be with Christ. He passed on to George that gentle assurance and faith that he seemed to lack. After what looked like eternity itself, pastor prayed with his hands still holding George’s and infused that assurance to him.

When he got up, George was smiling and seemed to have imbibed the peace and acceptance that he was struggling with thus far. I was amazed at the transformation of the man with the sincerity and the time spent by the pastor at his side. Wow! Miracle-workers, the medical team and the pastor! My heart went out to them.

Once in the vehicle pastor began to narrate how his wife always quarrels with him saying he has time for all the others but never for her! Everyone laughed and joked about this and the tension eased considerably. Next stop came.

This was a nice house, but construction of upstairs was going on and the place was a little messy. Here also the lady, Rajamma, mother of two sons and a daughter was lying in pain in her bed in the hall/sitting room. A curtain separated her bed and gave her a little privacy.

One look at the patient and I could tell this was a bad case. She was 60 plus, but emaciated, terribly weak, skins and bones, in the final stages of abdominal cancer. Her stomach has been sealed off in an operation and she was being fed with a tube. The Doctor and nurses attended to her, the woman groaned in pain and was not even able to talk; she just showed up some signs with her thin hands.

The doctor called in the family members, the daughter, one brother and the two daughters-in-laws who were all there and told them the bad news: their mother does not have many days left; it could be any time now. So try and keep her in comfort, give her the pain killers and keep her without pain and suffering; that is all we can do now. Be strong now and brace yourselves, her time is up.

The daughter started to weep; one of the nurses came running to tell the doctor that Rajamma was not responding; we all ran to the next room, she had the glazed look on her face, but revived in a few minutes, but was restless. Pastor loudly asked everyone, as if in a hurry, can he pray for her? They all said yes, please do. He sat next to her and prayed for her and when he finished she was motionless. I thought she had died in the pastor’s arms as he prayed.

A gentle heaving of her body told she was still alive and breathing. We left after comforting the family members. For once, we were all silent in the vehicle, for we had the premonition that she might die by the end of the day, if not earlier.

Oh, what a day! The team was still to go on and visit a few more patients, but I bid goodbye and hurried back to my place in an Ola taxi cab. I had had enough. My mind went back to the dying person and her family members.  What a tragedy and what a trauma! The human frailty in the face of the tragedy! 

Yet, Jesus overcame death, He was resurrected on the third day and ascended into heaven. This gives us, whoever believes in Christ, the assurance and the hope that we also will arise on the last day alive and in a glorified body and we will live for ever with Christ Himself. What a wonderful and glorious hope to live and die for.

Our sufferings and death on this earth are not without meaning or purpose. Terminally ill people, in spite of the long drawn suffering have time to think, reflect, accept the inevitable and put their trust in God. This is denied to those who suddenly die in an accident or heart attack. So the Bible says be ready always, we never know when our time to face our Maker will come. We need to give account.

Hats off to the Palliative care team! Imagine facing such human frailties five days a week, 6-7 cases a day! How do they cope up with this? Where do they go to find strength for all these? In a little humor and self-deprecation?

The doctor said, after a day’s work of visiting such patients, they all sit in the office room of the unit, discuss it all among themselves, pray and leave it all there itself and go home, so that they do not carry these to their homes and families. Formidable task!

My prayers go for them. They could find strength to do what they do day after day only in Christ in prayer. These are the people who do real service to the dying in their time of need and offer hope and courage for them to face even death with equanimity. True service to humanity, they offer.

God bless them and their families and their patients and their families.