Tag: intensive care

Slow deaths and sudden deaths

My parents both died slow deaths. My father spent the last three months of his life in hospital, of which the last month was in intensive care on ventilator support. He had been rendered immobile, and when the ventilator tube and food pipe went in, there was absolutely no way in which he could communicate to us during the brief times we were allowed to meet him.

My mother’s was a different story, but on a shorter time scale. She spent her last month in hospital, with the last ten days in intensive care and on ventilator, again what I think was fairly painful existence for her, living in a fairly isolated and airconditioned room, not being able to communicate with anyone, with all sorts of tubes and measuring devices stuck all over the body.

In hindsight, I regret my decision to allow them to be put on ventilator. I feel guilty for having extended their lives in a way which was both painful to them and where there was little meaning, for they lived cut off, and unable to communicate (and in both cases, had I thought rationally, I would’ve known that there was little chance the time on ventilator would allow them to recover). The only upside to this was that it gave me time to prepare. That it gave me time to prepare for their impending passing,

People who attended either of my parents’ funerals might have been surprised, a bit shocked even, to see that I was quite composed and in control of things. I wouldn’t be wrong if a number of them thought I was a heartless emotionless wretch. The reason I behaved thus was because it was only an incremental change as far as my mental preparedness was concerned. Till the day prior to both my parents’ deaths, I knew that the chances that they would recover and get back home was minimal. Delta. Epsilon. The death, normally a “discrete event” had only pushed this chance to zero, not a big change in probability.

I was thinking about all this two nights back when my grandfather-in-law passed away, once again after a prolonged illness (he refused to be admitted to hospital or be put on life support so in a way he was spared of time on ventilator), but his condition had deteriorated steadily enough for us to know that he would be gone soon. Several family members reacted quite badly, but several others were quite brave and acted bravely. The slow death was the reason for this, I thought.

There are too many factors that affect death, and no one can choose either the time or mode or pace of dying, but I have been thinking if slow deaths are better than sudden deaths or vice versa. The upside of a sudden death is that there is little suffering on the part of the dyer, but the discrete nature of the change (probability that the person would be no more the next day would jump suddenly from close to zero to one) would imply a huge shock for family members and friends, which they would take considerable time and effort to come out of.

A slow death, on the other hand, is extremely painful for the dyer, while it gives time to the family members to come to terms with the reality. Here, too, of course there is usually one big discrete step involved (like that Monday night when in the matter of less than an hour, my mother went from happily chatting with me to gasping for breath so uncontrollably that they had to immediately wheel her to intensive care and a ventilator; or that Thursday morning when my father suddenly realized he had lost all the power in his legs and couldn’t stand on his own), so it is more like a time-shifting of pain (for relatives/friends) rather than the pain being amortized over a number of days.

Once again, there are no clear answers to this question about which mode of death is better, but ever since I saw my father spend his last three months in hospital I’ve believed that sudden deaths are superior. I’ve found myself reacting to other people’s sudden deaths saying “good for them they went without suffering”. Again, no one really has control about how or when they’ll die. It’s only a question about what to hope for in life.

Hospital Issues

There is one thing that I haven’t managed to understand about Indian hospitals – it is the dependence on patients’ attendants. Every patient is required to have an attendant next to him/her all the time. In case the attendant is going out, he/she has  to literally take permission from the nurses. Full time, it is the attendant’s job to monitor the patient and alert hte doctors/nurses in case something goes wrong. And the main job of the attendant is to bring medicines.

Yeah, you heard that right. Most hospitals here have attached pharmacies, and the usual practice is for the doctor/nurse to scribble down a prescription which the attendant has to fulfil from the hospital’s own pharmacy. I find this practice weird and ridiculous, and wonder why the hospital cannot short-circuit the attendant’s role and then finally bill the medicines to the patient along with the rest of the bill.

Over the last couple of weeks when my mother has been in ho0spital, I’ve found myself being woken up at all times – including 1 am and 5am to go get stuff from the pharmacy. Sometimes it’s been as trivial as a syringe. Usually it’s a much longer list. Such a long list that given the crowd at the pharmacy, it’s impossible to check if the pharmacist has given you everything he’s billed you for. And in the wee hours of Tuesday morning when there was an emergency and my mother had to be shifted to intensive care, the first thing the people there did was to give me an extra-long list of stuff to get from the pharmacy. This was at 3am.

I wonder why this practice came about, and why it still exists. Is it to facilitate easy transfer pricing for the hospital? Is it t give some sort of transparency to the patient about the medicines being given to him? If the latter, can’t the patient just sign on the prescription authorizing the hospital to procure the stuff from the pharmacy? And given the monopoly power that the hospital’s pharmacy has, service is usually slow and inefficient, thus leading to long queues. And in such scenarios, it’s not easy to actually check if you’ve received everything you’ve paid for. And on top of this, you have the hospital giving multiple prescriptions for the same non-consumable thing, maybe just hoping you don’t notice.

And then there is this thing about the attendants. Thankfully we have enough extended family here in Bangalore that it isn’t hard to find volunteers to do vigil at  the hospital when I’m away at work or other things. But what if we were in a place with no relatives around? Or if the patient were living alone in the particular city? How would the hospital handle this? Would they make the patient himself run around to get medicines?

Whenever I think about these things I tend to get extremely pissed off. The hospital has been otherwise good. The nursing staff are all very nice and never crib. The hospital is maintained extremely well and is clean in most places. There are enough duty doctors at all times. And then they expect an attendant to be with the patient. And the expect the attendant to run around all the time to fetch stuff from the hospital’s own pharmacy.