LET GO

LET GO

14 mins
421


There was a party building up in the front lawn of a beautiful home in New Delhi built by Air Commodore Vishwa Pratap Singh Rathod. Simple decorations with tastefully positioned fairy lights and candles adorned the area...a small bar tastefully done, serving drinks, low-level music playing and chairs scattered to sit.

Guests poured in as Karan Singh Rathod stood in one corner looking at his mother across talking with Dr. Bagai, an eminent cardiologist and a family friend. The doctor walked up to Karan.

‘How much you look like your father! Hasn’t been able to ‘Let Go’, has he?’ he smiled mischievously.

He drew him to the centre of the gathering and popping open a bottle of champagne raised a toast, ‘Vishwa, to your journey of 92 years; of courage, determination, stability, trustworthiness, and patriotism. Cheers!’

 Everyone applauded and took a sip of the bubbly...and Karan thought of his recent journey. Of merely 38 days but covering immeasurable distances, comprising dilemmas, predicaments, tests; helping him crystallize unspoken key nuggets of wisdom from his Dad. A strange journey hardening him, softening him; at times abstract, metaphorical, even spiritual...giving the true meaning of Let Go, to be greatly treasured as he would travel through life henceforth.

The strangest thing about this strange journey is that it began with a word. Cheers! His father’s favourite word. He reflected...

                                                      ~~**~~

Four months ago, in the Emergency of the reputed MediGlobal Hospital, his father lay on the stretcher gasping for breath. He looked at Dr. Panicker, his pulmonologist, and whispered with great difficulty, ‘This is it Doc! I’m not gonna make it.’

He then looked at Karan and smiled. ‘Be strong son. Cheers!'

Karan looked at his father who would use this word freely- at the end of a sarcastic comment, to forget an ugly happening, when raising a toast to someone’s achievement or happiness; and sometimes for no reason at all. But he never expected to hear it here, in the ER.

Dr. Panicker asked the Air Commodore, ‘Why are you worried, Sir? 40 years of asthma and you’re going strong. Hallmark of a flying officer. A decorated one!’

The latter replied weakly, ‘Hope you remember my Living Will. I don’t want to be tied to tubes and machines. I want my death with dignity. Time to Let Go, onto the final flight!’

Karan drew a blank and Dr Panicker explained later, ‘Living Will is a written document that allows a patient to give explicit instructions in advance about the medical treatment to be administered when terminally ill or no longer able to express informed consent. It is passive Euthanasia.’

He added, ‘Your father’s Living Will is proof of his belief in the adage, Any fool can be uncomfortable! Usually when people utter that phrase they’re talking about sleeping or sitting down; but your Dad’s talking of dying. Ars moriendi.’

Karan looked at him, none the wiser. ‘Which is...’

He clarified, ‘The Art of Dying. Two Latin texts dating to mid 1400s offering advice on protocols and procedures on dying gracefully.’

                                                   ~~**~~

From the first moment in the ICU, Karan was mostly at his father’s side in cubicle 1409 hoping and praying he would return home soon. He was weak with advanced chronic obstructive pulmonary disease and doctors, nurses, attendants came checking on him several times a day.

A fortnight later, Aunt Vinita, his father’s cousin from Amritsar, came to see him. At first Karan did not allow her to meet him as she had been a trouble maker in the family some years ago. But his father had forgiven her as he always advocated ‘Let Go of past grudges.’

                                                     ~~**~~

Over the next few days Karan’s father’s condition stabilised; yet, whenever he was not in the ICU and his phone rang, he dreaded taking the call. These days were like a lull before the storm, and three weeks later, things began to slip. The antibiotics and sedatives were gradually stepped up, and his breathing was aided by oxygen but he was talking, albeit less coherently. He was dehydrated and sleepy. But he hung in there!

The Ventilator was a ‘No, No’ from day one. However, the black day dawned when the doctors said that the Air Commodore had become too ill to breathe on his own but had a good chance of recovery if they took this route- soonest; hence started a series of dilemmas and heart wrenching decisions for the Rathod family. Putting him on the Ventilator was equivalent to being on ‘life-support’. Then, wasn’t this flouting his Living Will, which categorically stated no ‘life-support’?

                                                      ~~**~~

Next day as Karan stepped into the hospital he stopped at the flower shop. Sometimes, it’s easy sharing a problem with a complete stranger and so he shared the predicament with the florist, a kind old lady. She chuckled, ‘Twenty years ago I Let Go my husband from the imminent vegetative state he was heading for. Doctors said he would live physically, breathe- but that’s all.’

Taken aback Karan asked, ‘Have you ever felt guilty?

She replied, ‘No, Never. His chances of recovery were one in a zillion, I would have only consigned him to suffering.’

                                                       ~~**~~

Aunt Vanita, however, thought differently. ‘Why would Bhai sahib want to hasten his own death? We are at the best hospital with medical care of international standards.’

Mrs Rathod then went to Dr. Bagai to seek his wise counsel. ‘Sixty years of togetherness where my handsome and fearless husband took all decisions; now I have to answer for us both. Where is the line between saving life and prolonging dying? When is the right time to tell a doctor, let my loved one go?’

‘See, Kanta,’ he started, ’Modern medicine today can prolong life through technological means. But both passively doing nothing to prolong life or withdrawing life-support measures have resulted in criminal charges against physicians.’

Adding, ‘On the other hand, families of comatose and ‘apparently-terminal’ patients have instituted legal action against medical establishments to make them stop use of extraordinary life-support.’

Mrs Rathod smiled, ‘So the medical guys get it either way!’

Dr Bagai smiled back, ‘Well it’s not that bad either.’

Karan now wanted some answers. ‘Whom was a Living Will for- the sick person, his kith and kin or the doctors? Was it operative before, or during the process of dying? When did the process of dying actually start? What was death, anyway?’ 

Dr. Bagai replied, ‘We’re talking of physiological death, Karan, when vital organs stop functioning and the digestive and respiratory organs fold up.’

Ultimately, Mrs Rathod took the decision. She said that if the doctors gave a good chance of recovery post Intubation, it was worth taking that chance.

                                                       ~~**~~

Intubation however was accompanied by another tube, the Ryles Tube, that passed into the stomach via the nose...for nutrition and water. The next 24 hours were to be a ‘wait and watch’ and Karan sat at his father’s bedside; numb, looking around idly.

In the next cubicle, a daughter and her aunt disagreed on the course of action for an 82 year old man. He overheard that there was a Living Will but the aunt, the man’s sister, opposed it arguing tersely, ‘How does one know what’s going to happen, we’re not Nostradamus! Why would my brother want to die?’

The daughter’s calm reply gnawed at his heart and shook him to the core. ‘Aunty, just look- Papa’s all tubed up. Now the urine process is malfunctioning; even with Dialysis over last 5 days there’s a daily trickle of 20-30 ml. This morning we’re told 200 ml...so we’re overjoyed. Has anyone ever been so jubilant upon seeing 200 ml of their father’s urine? Then we learn that it was accumulation stuck in the tube that gushed out all at once. So we’re crestfallen! But the reality is deterioration of the body and suffering. Anticipating this, Papa must have desired to expedite his dying process.’

The aunt called it doctor-aided suicide, illegal. That’s when the daughter showed a newspaper cutting of a recent Supreme Court judgement upholding patients’ right to refuse life-support via a Living Will.

                                                     ~~**~~

Three beds away, doctors had refused to disable the pace­maker for an 86- year old lady. Her middle-aged son Thomas Rajan who had rushed in from the US argued if only his mother could see her own state of dependency she would want that pacemaker deactivated. The sisters disagreed vehemently. ‘What if she improves? What if there is a miracle? Besides, the Bible doesn’t allow it.’

Karan bumped into Rajan at the hospital food court the next day. The latter told him that Living Wills had great acceptability in the US but at the same time, crazily enough, tech-titans like Larry Ellison of Oracle, Elon Musk of Texla, Bezos of Amazon...were pouring billions into research for longevity and immortality, wanting to beat death.

Half amused Karan recalled his father saying a year ago, ‘From moving freely across skies and continents not very long ago, I became restricted to the house, then constricted to a room and finally relegated to a bed. At each stage I’ve Let Go of several unfulfilled dreams and possessions that I accumulated with pride. Now, I’ve lived way too long; it’s very difficult to walk, eat without dropping food, go to the bathroom without help... and this will only get worse. Then?’

Karan replied they would get attendants, nurses to take care but his father lamented, ‘Living long in that condition will be a curse!’ 

Karan wondered if his father’s Living Will would hasten his death, make it more comfortable? More dignified? Would it be calm, peaceful or shocking and hard-to-witness?

                                                     ~~**~~

Later that day, when he and his mother were sitting with the Air Commodore, the attendant asked them to leave the cubicle for a few moments for their daily 4 pm routine of personal hygiene to be administered. Karan thought how upsetting and disquieting it must be for his mother to see her valiant husband no longer able to care of himself. No wonder old age was referred to as a ‘second childhood’.

                                                     ~~**~~

Air Commodore Rathod successfully got off the Ventilator which, for a nonagenarian, was no mean feat. He was fighting valiantly and though life-support was slowly reduced, 30 days in ICU took its toll. He slipped into reduced wakefulness and disorientation with slowed responses to stimulation. Yet whenever he opened his eyes weakly he would first raise his thumb as if to say Cheers! and then motion Karan to give his hand to him. Clasping it with both his hands, he would shut his eyes but not let go. Perhaps he was transmitting knowledge, experience or just his reservoir of sixth sense. And this reminded Karan of his own youthful 20s when his father had a stern eye on his activities fearing he shouldn’t go astray.

A day later came another blow. Dialysis. The Rathods were told that this was, in all probability, a temporary phase and that Air Commodore Rathod would bounce back; they could take him home soon. But guilt pangs hit the family again- another machine for life support! Weren’t they going against his wishes as specified in his Living Will?

Five days later with no signs of improvement, Karan helplessly saw his father back on the Ventilator. Doctors said it was time to consider ‘No further intervention’, letting nature take over marking the end of his struggle. Beyond this he would suffer long-term end-of-life nursing care.

So, what did one have to do to ‘Let Go’?

The ICU Head explained. ‘Whatever life-support systems and levels of antibiotics are being administered, stay. Nothing will now be added or introduced as that will only increase medication, intervention, greater pain, discomfort, and suffering to the valiant officer.’

Adding profoundly, ‘Think of ‘No further intervention’ as correction of your not having adhered earlier to his wish in this regard. You were hesitant to have him on the Ventilator. Now, here’s your chance to redeem the mistake, if you think that was a mistake.’

Aunt Vinita disagreed. ‘Should we think of injured or retired officers as a burden? Should we hasten their end? ’

Kanta Rathod was miffed. ‘Be quiet Vanita. Our painful dilemma today is- should we sign ‘No further intervention’? Are we right in doing so?’

Aunt Vinita was emphatic. ‘No, you’re not right! VishwaPratap is a flying officer, a Gallantry Award recipient for flying skill and bravery above the call of duty in the 1965 operations. He defied death then in the skies. I cannot imagine him taking a less courageous route now. Hinduism doesn’t permit it either.’

Karan looked at his father, marvelling the quintessential ‘Officer and a Gentleman’. Monarchic, demanding, and yes, sometimes unreasonable too. Yet with utterly impractical heroic intentions he announced, two years back, he wanted to visit the Golden Temple in Amritsar. And visit he did.

                                                        ~~**~~

Mrs Rathod went to the ISKCON temple the next morning to concur with the Head Priest who ostensibly told her it was not a question of ‘letting go’ but that of ‘letting him come...fly into’ the abode of Lord Krsna.

She told her son she would let him know of her decision by end of next day. Only at next day dawn did Karan realise it was Karva Chauth, a married woman’s day of fast and prayer for the safety and long life of her husband.

True to her word, after the rituals were over late evening, Mrs Rathod called her son and quietly nodded.

                                                       ~~**~~

It was Day 36 when Karan signed the ‘No further intervention’. He was scared, very scared, at what he had just done. Dr. Panicker was gentle. ‘Infection has set in deep, and the body is devastated, not responding even to the world’s most potent antibiotic. Only a miracle can pull him out of this. But then also, it will be very difficult for him; and painful.’

In deep anguish Karan asked, ‘So, sir, should we pray that a miracle does not happen?’

                                                        ~~**~~

Day 38. Karan got up with a start and reached for his cell phone that was ringing. It was 5 am. The call was from the hospital. ‘Sir has just had a seizure. Please come immediately.’

Karan rushed to the hospital. His father, with tubes crisscrossing his frail body, was breathing in short gasps. The Ventilator care was neither stepped up nor halted. The blood pressure was falling, and doctors on duty advised that the end of the body was imminent, perhaps just a few hours away. He called up his mother asking her to come at mid-day instead of her usual evening time.

When Mrs Rathod reached the hospital she picked up a rose from the flower shop. Placing it next to her husband she sighed and with moist eyes bravely took a long proud look at him. How handsome he looked... having had a shave, eyebrows trimmed, adorning her favourite after shave musk Paco Rabanne. She sat calmly, gently caressing her husband’s right hand imploring him to open his eyes, if only for a moment. She asked, ‘Shall I sing for you?’

There was no response. The Om mantra and Mahamritunjay mantra played softly on his cell phone stuck at his pillow side.

Mrs Rathod left. Wringing his hands in angst, desperation, helplessness Karan asked his father tearfully, ‘Dad, we have to go home, right? Please open your eyes...’

Suddenly, the attendant shouted out a protocol and he was asked to step outside the cubicle. Two ICU doctors hastened in. Minutes later one of them came out and said grimly, ‘We tried normal CPR... didn’t work. Should we get aggressive?’

Karan knew his father was feeble, his vital organs were dysfunctional and infection had devastated his body. Aggressive CPR would probably break a rib or two. With tears in his eyes he said, ‘No.’

The doctor went in and, in less than a minute, came out. ‘We’ve lost him!’

Karan drew the ICU cubicle curtain slightly and walked in. His father lay right in front of him, yet he was no longer there. That’s when it struck him how one is always told about the importance of the body and how we must take care of it. And then, in less than a fraction of a second, the body became inconsequential- to be suitably disposed off. So, what was the real story- was the body important or not?

Filled with guilt for having given the nod of assent to let his father go, he would never be able to forgive himself. He looked at the doctor and asked, muffling a sob, ‘Would we have saved him if you had aggressive CPR?’

The doctor replied, ‘We would have just his heart beating, and the monitor up there ticking...’

Adding gently, ‘Your Dad was prepared to struggle, and struggle he did. For so many days...Yet he made and signed a Living Will because he did not want to suffer. Thin line.’

                                                       ~~**~~

Karan came out of the building, sat on the kerb, shattered, overcome with guilt. Was a son supposed to look after his father in old age...or sign his life away? What right did he have to do what he did? Who was he, anyway? He cried and cried. Then, he saw Dr. Bagai walk up to him and hand him a note. ‘Your Dad gave this for you...the first day he was in ICU.’

He opened it and read: ‘Dear Son, I know what you are going through...hence this note. When I wanted you to Let Go it didn’t mean I did not care about you all. And when you did Let Go it does not mean you all did not care about me, or love me any less. Let Go of the attachment. Let Go.’

                                                       ~~**~~

On reaching home, his mother consoled him, ‘Only the blessed and fortunate provide physical care for their loved ones in the last hours.’

Three hardest moments of Karan’s life sailed in front of his eyes. One, when in the beginning, he went against his father’s Living Will allowing doctors to put him on the Ventilator. Second, when he signed the ‘No further Intervention’. And third, today, just an hour ago-the hardest... disallowing aggressive CPR.

Karan asked with his head hung, ‘Did I do right, by signing his life away?’

She replied calmly, ‘You didn’t....sign his life away! Everyone has to leave, go...die. Even Lord Krishna and Ram did. It’s the law of nature.’

He looked up, as she continued, ‘Your father was born at dawn. During his life, let’s call it ‘the day’, he weathered the sun, rain, snow. Now it’s evening. Dusk. Let him retire. Let him go on his final flight, son...Let Go. We’ll celebrate his birthday in December.’


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