Life and Death

As soon as one is born, one starts dying.

Luigi Pirandello, Henry IV

Life is a creation of God which has always baffled me. Should I call it a creation, or what else should I term it, I don’t know. One can clearly differentiate between  a live and dead person. But what exactly is life. Is breathing the sign of life, as one can stop breathing for minutes and still stay alive. Is it the beating of heart, as one can stop the ailing heart for hours during open heart surgeries?. Is it a functioning brain as we see a number of brain dead people living in vegetative state for months? .Where exactly is life in our body?. Philosophers would call the heart to be the abode of life. while scientists would like the brain to be the core of life. When does an embryo get life? I took my wife for antenatal viability ultrasonography scan , where I saw a beating heart in an embryo just more than 2 inches  in size. The first sign of life ! but what about the cells which united to form the embryo at the first place. They travelled long distances and crossed many hurdles for the great rendezvous. They too were live and energetic.

 

If life is so miraculous and mystic, so is death. As a doctor this is the most difficult question I have faced. When to call a person dead? When I am called up towards a dead or dying person, my heart aches and my mind termbles. It is called declaring a death. It means the person is already dead and everyone knows it. You just have to confirm and proclaim it. It is a very tough situation. When you go there, you would find a very monotonous air. Some of the relatives would be standing by the side of the bed waiting for my arrival. Their faces resemble the dam waiting to open its shutters. They would be staring at your face like some Amazonian animal. Watching carefully your every movement like the animal of prey. Scrutinizing the pulse you palpated and the heart beat you checked. Each time they would look at your face for a hint about the situation. Still not ready to open the gates of tears. Some of the relatives might have already started to arrange for the ceremonies informing other relatives, arranging the chairs for visitors and starting to chant verses from the holy books. I often ponder what my role there is. Just to say the word and break the silence. I find this job tougher than that of Yamraj or Azrael or Hades ( angels of death) for they have to just follow orders. May be they too would be there waiting for my death sentence. The moment the proclamation is made , there erupts starts a violent cry from all sides. You feel as if you have condemned the patient to death sentence.

The most beautiful description of death I have read is from a short story “ The kite maker” by Ruskin Bond.” The voices in the street grew fainter, and Mehmood wondered if he was going to fall asleep and dream, as he so often did, of a kite so beautiful and powerful that it would resemble the great white bird of the Hindus—Garuda, God Vishnu's famous steed. He would like to make a wonderful new kite for little Ali. He had nothing else to leave the boy.

He heard Ali's voice in the distance, but did not realize that the boy was calling him. The voice seemed to come from very far away.

Ali was at the courtyard door, asking if his mother had as yet returned from the bazaar. When Mehmood did not answer, the boy came forward repeating his question. The sunlight was slanting across the old man's head, and a small white butterfly rested on his flowing beard. Mehmood was silent; and when Ali put his small brown hand on the old man's shoulder, he met with no response. The boy heard a faint sound, like the rubbing of marbles in his pocket.

Suddenly afraid, Ali turned and moved to the door, and then ran down the street shouting for his mother. The butterfly left the old man's beard and flew to the mimosa tree, and a sudden gust of wind caught the torn kite and lifted it in the air, carrying it far above the struggling city into the blind blue sky”.

Declaring a dead in a hospital is much easier , but dramatic. Most often the relatives might have been briefed regarding the grave prognosis of the patient and their mind would be well set to receive the news. But here we are obliged to perform some rituals as I would call it. Unless the patients general condition is good and the death state occurred due to some acute reversible cause ,the resuscitation efforts are usually futile. The cardio pulmonary resuscitation which the patient receive would often put a morbid patient from a state of dead to a no man’s land where he is neither dead nor alive. The violent compressions on the patients chest often breaking the rib bones stimulating his weak heart to beat and the endotracheal tube inserted into the patient’s throat providing artificial ventilation would temporarily put the patient into a period of uncertainty, but the patient would eventually succumb to the inevitable. I remember a joke I read in a journal. The guardian to the gates of the heaven once heard a knock at the gate. He eagerly opened the door but saw no one there. We he returned he again heard the knock. He again opened and to his dismay no one was there. This routine repeated 4 to 5 times and at last he found a happy person when he opened the gates. With a bit of anger the guardian asked the person,” were you playing silly pranks with me”. The person replied,” I had a heart attack few minutes ago, that is when I knocked the door the first time , but the poor doctor was resuscitating me”. A flat electrocardiograph (ECG) would often confirm the death. There is no wails or howls, just a silent mourning as everything is as expected and explained.

Life is considered pleasant and cheerful and death is often gloomy and mournful. Someone has rightly said that when you are born you cry and when you die others cry. Life and death being antagonists, it is quite true to say that every moment of life is a step towards death.

- the eldest son