Sunset and Evening Star

Sandeep Girish Bhatnagar

“Take him away if you like,” said the doctor.  We were seated in the clinic of the head of nephrology at the military hospital in Colaba.  It was like any of the other dozen or so clinics that we had visited in the past few days: not a speck of dust anywhere, gleaming steel instruments all around.  A general air of confidence emanated from the surroundings, everything was so in place and high-tech.  It was all very reassuring.  But as someone once remarked, “Every prospect pleases and only man is vile.”  Memories of yesterday: scraps from songs I had heard, scenes from plays and films I had seen and stories I had read, passed through my mind in no particular order.  I was tired of thinking about the matter at hand and my mind did everything it could to avoid the present. The present was so difficult to deal with, while the past was rose tinted.   I had to literally drag my mind back to the present. There would be time enough for reminiscing once things returned to normal.  

I refocused on the doctor seated before me. He was short, with a very army mustache and the general features of a bank clerk. His bottle-green uniform was ironed to perfection. On the table before him was a huge tome with the words, “Harrison’s Principles of Internal Medicine” inscribed on it. He had the habit of absent-mindedly flipping through its pages as he talked. My brother listened attentively, while my mind wandered. I had heard all the doctor had to say a number of times and was absolutely sick of it. However, I had a lot of pleasant memories linked with this hospital.  It combined a mix of old very army barracks and state-of-the-art medical equipment, housed in ultra-new, white buildings. I had visited it often as a child, mainly for cuts and bruises. In later years, I used to bring my parents here for regular check-ups. It was a place I used to trust blindly.

Today, however, things were different.  My father was in a drugged stupor and the hospital staff had given up hope of recovery. His diabetes had led to the deterioration of his kidneys, to the extent that his body was no longer able to expel toxins without the help of dialysis. This was done with the help of machines which took out his blood, purified it and put it back in place. It was a painful procedure but my father was stoic. He said he was still searching for the reason he had been sent into this world. Five years ago, when my mother passed away, we had attended a prayer meeting, hosted by an old professor of mine, who was a great follower of the teachings of Sri Aurobindo. During his sermon on the frailty of life, illustrated by the enchanted pool incident from the Mahabharata, the speaker had stressed on the need for each of us to find our mission or goal in life.  “Everyone has been sent here with a purpose. Most of us spend our entire lives trying to find it. The more fortunate ones succeed.” This had gone down rather well with my father. Thereafter, he often declared that he was going to find his mission in life, come hell or high water. But man proposes and God disposes. My father was at this moment between the living and the dead and all because of the general slackness of the military doctors.

I had worked with retired naval officers on board merchant ships and had not been very impressed by them. No doubt some those who had been professional navigators in the navy were competent ship handlers; but most of them showed a kind of disdain for cargo work, which is the very basis of merchant shipping. Despite this, I had always presumed that they knew their onions when it came to medicine. After all, they had the best of equipment and the training imparted to them at the ArmedForcesMedicalCollege was supposed to be among the best. They sad fact was that they illustrated the old Hindi aphorism:”Naam bade aur darshan chhote”.  I had been appalled by the condition of the hospital wards, particular the ICCU. Disgraceful was an understatement. From what I could make out, they were still playing the old sahib game: pretending to be brown British officers. No doubt most of them looked impressive in sparking whites or greens, depending on the branch of the armed forces they belonged to, but that was as far as it went. I found little of the enthusiasm one would associate with so challenging a profession as medicine.

“Have you read this?” asked the nephrologist. ”It is a list of good dialysis centres in Bombay.” (He still referred to the city as Bombay, though the name had changed to Mumbai ages ago) He handed over a small booklet to my brother, which we pretended to interest ourselves in. All the while, however, my mind was on my father. He was lying prone in his ward, physically immobile but with alert eyes that seemed to take in all that went on around him. Earlier in the day, this very doctor had in stentorian tones proclaimed my father’s demise, not realizing that the old man’s mind was still under his control.

“See there. He has forgotten to breath,” he had quipped in delight as he examined my father. This observation was addressed to an intern, who dutifully recorded all the drivel that poured out from his senior’s mouth. Right now, he was in charge: it was his office, his hospital, where he could summarily deal with anyone who did not conform to his theories of medicine.

My brother, also an army colonel, finished glancing through the booklet and we patiently waited for the diatribe to continue. Emboldened by our silence, the doctor moved on to his favourite topic: the so-called “dignity of life”.

“I remember him,” he said in a patronizing tone. “He used to visit me regularly. His pointed shoes polished to perfection, his trousers neatly pressed. All very spic and span.” He nodded his head approvingly.  “It’s really rather sad when someone you know gets into this condition.”

My eyes wandered to the window behind him. It was evening and we had a glorious view of the seaside.  I could see the sun setting. It’s orange rays lit up the sailing boats that winged around like lazy white seabirds, occasionally darting around as the wind picked up.  They were from the Naval Sailing Club nearby. On the horizon were naval frigates and a couple of merchant vessels.  It was a cheerful scene and it consoled me a bit.  In times of desperation, even simple things can act as straws.

The doctor went on with his lecture. He seemed to have forgotten that the two people seated before him were relatives of the dying man. ”There was this colonel, whose father developed kidney problems,” he said in the manner of one recalling an anecdote for the benefit of friends at the club. “The colonel’s father was also an army man, a brigadier in fact. They used to visit me regularly but the serum creatinine  levels continued to rise. One day, the brigadier asked: ’What will happen when this rises further?’

’ You will need dialysis,’ I replied.

‘What if you don’t dialyse me? ‘

’ You will fall into a deep slumber and pass way.’

He thought for a moment and then said, ‘Then don’t dialyse me.’ ”
At this point, the good doctor’s eyes lit up. He was in his true element now. Everything reached him a bit late. While world opinion had shifted from a pro to contra stance regarding mercy killing, the good doctor was in the mid-90s mood of letting patients go, if they so deserved it.  Naturally, it was left to him to decide as to when the oxygen supply was to be cut off and for whom. He tapped his copy of Harrison’s Principles of Internal Medicine, whose pages he had been glancing through as he
talked, before continuing:

“So we didn’t dialyse him. We just made him comfortable.”

The word comfortable was intoned in the manner of connoisseur savoring a rich new blend of wine and finding that it met with his approval. “At last, when he passed way, his colonel son presented the Officers’ Ward with a silver tea set.”

The doctor’s eyes gleamed with appreciation. Such as noble gesture! I could have sworn there were tears in his eyes as he marveled at the enormous dignity of it all. Such grace, such panache. I thought for a moment that he was going to go all the way and burst into “Auld Lang Syne” or “He’s a Jolly Good Fellow”. All in a very proper, pre-World War II British
manner. My brother and I smiled as we wanted an ”honorable” discharge for my  father.  Technically speaking, the doctor could not refuse our request; but we wanted things to go smoothly.

“You know, he too asked me, as to what would happen if dialysis didn’t work out and theserum creatinine levels became uncontrollable,” droned on the doctor.  He was now speaking about my father, though he never bothered to refer to him as ‘your father.’ “ ‘Then, you will pass away,’ I replied.  At which, he merely shrugged his  shoulders and shook hands with me,” added the doctor.   

There was a moment of silence as we waited for the doctor to continue. His voice was choked with emotion, so moved was he his own virtuoso performance.  “One day, I too will pass on,” he said and made a wry face, while gesturing expansively with his outstretched hands  in a manner that was supposed to convey the majesty of one who was on the threshold of assuming the post of the Head of Medicine at the Military Hospital in the very near future .  I did not say much, since I had already incurred his wrath  earlier in the day. We didn’t see eye-to-eye in matters concerning life and death. He cared two hoots (an archaic expression still current in the army) whether my father lived or died, while I wished to prolong his departure by as much as I could. “Since he is going to die, we thought we should take him home,” said my brother seizing the opening. “You know, home surroundings, his own bed.”And grand-children,” interrupted the good doctor, not to be outdone in courtesies. He reminded me of General Musharaff for some reason. They were so alike in appearance and possibly temperament, too.

“And grand-children,” agreed my brother smiling in the prescribed army manner. After all, the good doctor had to be humored.

“The dignity of life,” went on the good doctor, happy that he was being asked to set  forth general statements rather than to treat a case.

“So … May we take him home?”

“Of course, by all means,” smiled the doctor.

“You have already  given us the list of dialysis centres,” said my brother handing him the discharge papers, which the good doctor signed without a murmur.

“Do you want my advice?” queried the doctor, emboldened by our courteous behavior. “Don’t dialyse him. Let him sleep. He won’t even know what happened.” He paused for dramatic effect.  Had we applauded, he would have burst into tears of joy. “He won’t even know what happened,” he repeated.

“That’s not for me to decide,” said my brother, deftly picking up the discharge papers as we got up to leave.

“Of course, of course, by all means,” said the doctor as he continued with his fake, inane chatter.

“And that’s what I told him,” he added, a dismissive fore-finger pointing in my direction. He said this with a face-turned-away, very-turn-of-the-last-century, straight-from-Premchand gesture, which was supposed to signify extreme disdain, mixed with a sense of calculated insult. The doctor had a complex personality, made up of elements formed from a mix-n-match collage of influences. Somehow, he had had managed to pick the worst of all he could from those around him. I dare say, his own opinion of his behavior was quite different. He hated anyone challenging his diagnosis. I was the object or recipient of his ire because I had made the cardinal error or rather unpardonable faux pas of contradicting the doctor when he pronounced my still-living-and-breathing father dead.

Within an hour, an ambulance arrived and we were on our way to BombayHospital to try to undo the damage done by the good doctor and his entourage.

*****

“I don’t like this,” said the young doctor pointing to the tube being used to force-feed my father. ”He is an army man. Let him eat on his own. Remove it.”

Actually, my father had served in the Indian Navy and not the Army, but I let it pass. For most civilians “military” and “army” are synonyms.

The doctor turned meaningfully to his assistant, a taciturn young man of a somewhat dour aspect, but an excellent bedside manner. We were now at Bombay Hospital, with all its old world charm, situated a short distance from Metro Cinema and the fabled Irani Cafes that served  delicious tea and cupcakes. The hospital seemed to exude reassurance to all who visited it: efficient looking nurses, headed by a shift matron, hovered around the patients, as benign ward-boys deferentially changed bed linen or swabbed the floor.  Our doctor was an energetic, bespectacled nephrologist, with a good reputation in medical circles. He eyed his patients in the manner of an artist looking at one of his paintings. He reminded me of an old school friend, who bowled medium pace and was pretty useful as a long distance runner.

Although we had heard that our new doctor was a member of the medical avant garde,  the idea of removing the feeding tube that went in through my father’s nose was much too daring a course of treatment for us. There were three of us beside my father’s bed and all three were aghast. My father’s younger brother had journeyed down from Pune. Of a very cautious disposition, he turned visibly pale.

“What if he doesn’t eat?” asked my younger brother apprehensively. He had replaced my army brother, as the latter had to return to his unit.  

“Don’t worry, we will give him Celemin Nephro during
dialysis,” said the doctor, referring to a food supplement.

Somehow, we managed to retain the food tube for a whole day. We were not ready to take any chances, at least, not while my father was still breathing. The young assistant of the nephrologist, however, saw things differently.  

“Why isn’t this out?” he queried, when he came to examine my father in the evening. He took out a pair of latex gloves from a box next to my father’s bed, put them on and proceeded to extract the food tube. We almost fainted on seeing black liquid emerging along with the tube.

“Don’t worry, that’s just one of his tablets. It’s black inside the capsule,”  said the intern as he pointed to a strip of capsules that lay in my father’s box of medicines.

My father was pleased with all the attention he received at the hospital and within a quarter of an hour, he had worn his dentures and was slowly chewing his food, as he appreciatively took in all that went on around him.

He was back with the living.

The following day, my father graduated to reading newspaper headlines. By lunch time, he even volunteered to drive during the homeward journey.

When the neurologist  made his rounds,  we learnt that my father’s drowsiness was on account of being administered medicine for Parkinson’s disease when he was not inflicted by this illness. I was feeling fairly relaxed and  even took time off to read a  book I had picked up from the New and Second Book Shop, which was across the street from the restaurant where I bought boiled eggs for my father.

When the  nephrologist  looked in to examine my father in the evening, my father’s eyes immediately darted in his direction. There was a smile on his face, which was radiant with confidence. The doctor’s face also broke into a smile when he realized that his diagnosis had been correct.

“Where are we?” he asked my father as he examined him with his stethoscope.

My father was not sure and admitted as much in a free and frank manner, which did him credit.

“Bombay Hospital”, I prompted, “And where is Bombay
Hospital?”

“Girgaon,” responded my father, much to the delight of those assembled around him.

“Who has won the elections?” I asked.

“Congress.”

“And who is to be the prime minister?”

“Manmohan Singh,” came the prompt reply. He had gathered all this from the newspaper headlines.  He then went on to voice his approval of Prime Minister Manmohan Singh and US President Obama. My father liked people of maverick dispositions. He was a great admirer of former Indian president Dr A.P.J. Abdul Kalam, and had taken his autobiography, Wings of Fire, with him during his previous trip to the hospital. My father had read the entire book, cover to cover, and often quoted extracts from it.  

Now that my father was showing signs of recovery, we could start thinking of things other than ICU wards. For instance, I wanted to make a final trip down to the New and Second Hand Book Shop before we went home. One could spend hours browsing among those delightful, dusty volumes. The attractions of the Irani bakeries could also not be denied. Indeed, there was really so much to do now.