The Cost and Rewards of Caring…a self-reflection about caring for the dying – Part 2

“When we stand on the low rungs of the ladder of sorrow we cry

When we come to the middle we are silent

But when we climb to the top of the ladder of sorrow, we convert the sadness into a song.”

(Ancient Hebrew Poem)

My patients and their families find themselves on top of this ladder…the songs either sad or stoic; fearful or courageous; peaceful or disturbed. Whatever the song, I have learned to sing it along with them.

And to answer the questions…

Is it difficult?

As a young doctor all I wanted to do was save lives, cure diseases, and fight death. Now in palliative care I do neither. From trying to restore health and eliminate disease I now try to ease the suffering; rather than fighting death now I manage it actively, honouring death just as I honour life. From trying to “treat-cure” now I try to “heal”. The tightrope walk between continuing aggressive treatments and letting go of futile ones, between leading and listening, has been one of the most challenging aspects of this journey.

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The patients that I see at my workplace have cancer that is not curable and multiple symptoms. They may have intolerable pain, uncontrolled breathlessness, persistent vomiting, or poor appetite. They may be anxious, scared, depressed and unable to sleep. They are weak and frail both in body and in mind.  They may present with complications of the cancer, multiple infections, or wounds that need to be taken care of. In addition the families are in distress, having no money for medicines or even for food and many of them from remote villages in India have no access to medical care. Addressing these multiple complex issues is a difficult and an uphill task.   There are times when I have been uncertain, when I have been plagued with self-doubt, and have felt inadequate.

So how do I cope?

“The capacity to learn is a gift

The ability to learn is a skill

The willingness to learn is a choice”

                       —Brian Herbert

Learning is life-long in medical profession. I have a simple principle…”When in doubt, check it out.” When I am challenged with a complex issue I seek help… from the books, from my seniors, from my juniors, from my peers, and from my team. One of the common fallacies among many, even the medical fraternity, is that palliative care is more about care and less about medicine. To set the record right, it is a beautiful amalgamation of evidence-based medicine with compassionate care, one without the other is worthless. While I believe to large extent compassion is innate, there is plenty of evidence and guidelines in palliative care literature that can provide answers to the medical uncertainties. All it needs is an enquiring mind, willingness to learn, and a process of reflection. Every experience teaches you something and I learn by asking:

  • What happened
  • What did I find difficult
  • What did I find easy
  • Why was it difficulty or easy
  • What do I need to do to improve
  • With the knowledge gained how would I handle this differently

I take these small steps every day with a hope and prayer that today I am more competent and effective than I was yesterday.

Am I strong?

“Knowing what it feels like to be in pain is the reason why we try to be kind to others,” said Jiraya, one of the three legendary ninjas from the Naruto series.  Human suffering is fraught with unpleasantness yet accompanied by beautiful acts of compassion. Compassion is “suffering with or feeling for another” accompanied by a “desire to and act of relieving the suffering”. Empathy on the other hand is “feeling as another or mirroring of another’s emotion.” Compassion is not just caring, but involves taking action to relieve that suffering. While compassion was inherent part of my personality since childhood, my upbringing in an environment where care, kindness and acts of altruism were the norm further strengthened this trait thereby influencing my choice of profession. Empathic engagement is central to psychiatric practice and this was a skill I had honed during my professional training in psychiatry. Compassion and empathy are fundamental skills that one requires in palliative care.

“Trials teach us what we are; they dig up the soil, and let us see what we are made of,” so said the Prince of Preachers, Charles Spurgeon. Over the last few decades a lot of relentless digging has been going on in my life. The immature mind like the iron ore was smelted in the furnace of life.   Tempered by the fire of adversity the molten mind embarked on a journey of self-discovery and self-awareness to reveal an inner core of steel. Over the years I have learned to bounce back and adapt, however arduous the journey may be. This readiness to meet and cope with challenges, manage ones emotions, and exhibit a sense of control is termed resilience. Both nature and nurture has contributed to this hardiness within me.

It was with these skill sets of hardiness, compassion and empathy in my toolkit that I entered the field of palliative medicine. And these qualities have stood me in good stead in my journey here, helping me maintain the crucial balance needed for healthy and stable functioning.

Every day I meet patients and families afflicted with incurable disease. At times their suffering and distress resonates within me and tugs at my heartstrings. To witness the suffering and death of children and young adults is particularly agonising. I traverse this continuous cycle of suffering and death, one patient after another, often simultaneously… a journey that is emotionally exhausting.

So how do I cope?

When confronted with extreme distress in patients and relatives I don’t have a problem shedding tears…even in their presence. It is important to let the pain of loss flow through you and out of you. I have experienced the spectre of death when my mother had a near fatal accident. The professional grief that I experience is not as intense as personal grief; there is some sense of control. As Dalai Lama rightly said, “Your own pain is involuntary; you feel overwhelmed and have no control. When feeling the pain of others there is a feeling of discomfort, but there also is a level of stability because you are voluntarily accepting pain. It gives you a sense of confidence.” If, on those rare occasions, the grief is overwhelming I withdraw, take a break. I seek help from my colleagues, peers or friends; the human connections I am blessed with and do activities that relax, rejuvenate and restore my balance.

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Our grieving is as individual as our lives and we need to find our own way through it. We sometimes tend to get attached to a patient because we identify with them when their life circumstance is similar to ours. Being aware of this risk and attempting to maintain professional boundaries lets us tide through such situations. Once you recognise the blurring of boundaries getting a colleague involved in caring for such a patient is the way forward. We need to be aware that while we attend to and monitor the needs of the patients, we need to simultaneously take care of our needs too. Self-knowledge and self-awareness will keep us on our feet in this difficult journey. Self-care is not selfish.  If the vessel within you is empty, you cannot serve.

Being aware of one’s limitations both as an individual and as a clinician is an important skill in life and in medicine. You may be able to relieve the suffering of most patients, but not all, and definitely not at all times. Over the years I have become less critical of myself, accepting and acknowledging my failures and inadequacies, and working to improve them. I have learned to notice, value and respond to my needs as generously as I attend to the needs of my patients and relatives. “Forgive yourself for not knowing what you did not know before you learned it.”

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Sunset at Haji Ali                             Worli Sea Face                 Bandra Worli Sea Link

The one-hour journey back home takes me through some of the most scenic stretches in Mumbai. The cadence of the sea puts me in a trance…the hues of sunset soothes my nerves. To quote John Burroughs, “I go to nature to be soothed and healed, and to have my senses put together.” This is where I shed my role of a palliative care physician/doctor. The traffic is a blessing for me…as this gives me the time to wind down after an exhausting day.

I cherish the human connections I have made along the way, each and every one of them. I am blessed to have them.   They help me reconnect with the outside world. My family; my friends from school, “DHS 84,” with their random banter keep me in splits every day; those from medical school, “Naughty Nine,” the girl gang whom I turn to for hugs and accolades; the “Hot Moms,” a cabal of weight watchers with shared parenting woes; and “Pall Friends,” three friends who have embarked on this difficult journey together…and then that one special connection that withstands the test of time, that understands the unsaid, makes you smile through the tears and quietens the soul. These connections nourish me, keep me grounded; my safety net at all times.

“Write hard and clear about what hurts”, said Ernest Hemingway. Writing helps me cope…it helps me understand and express my emotions…it gives me a voice…it clears my mind and helps me hear the whispers of my soul. Writing heals me. It is important for each one of us to find that one pleasurable activity, that one hobby that helps us heal.  My blog keeps me going…

“Is it depressing?”

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I work in a landscape of death and suffering. I connect with the sufferings of my patients and relatives…I grieve along with them, I experience the effects of their suffering, sadness, shock, distress, though not first hand…this is called secondary trauma or vicarious trauma. “All suffering prepares the soul for a vision,” said Martin Buber. Along with suffering I also witness the capacity of the human spirit to thrive despite the adversity, aptly named indomitable human spirit. Just as I grieve I learn to grow with my patients…by observing, by interacting…this is called vicarious post-traumatic growth.

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All of us will die one day. Death is the only certainty in life. Being aware of one’s mortality makes us anxious. I was anxious…prone for panic attacks, especially while flying or travelling, triggered by the fear of dying myself or of losing someone close to me. I was frantically trying to control the future and keep everything and everyone safe. And then I entered the world of uncertainty, suffering and death. Today death is no longer a stranger in my life but a frequent visitor lurking in the shadows every day. While some meet him in stoic acceptance others are distressed by his presence. Will I meet him in stoic acceptance or will I be distressed…I ponder!

So how do I cope?

This constant proximity with death and dying reminds me of my own mortality. When I accepted the inevitability of death and dying as an integral stage of living, my fears started to diminish. Dying well then became another task of living that could be mastered with the right information, at the right time, with the right choices, in the right place. What are the interventions I would like and would not like at the time of imminent death? Where and with whom would I like to spend the last days of my life? As I started to think about my death actively and directly, and prepare for it I was able to transcend the feelings of anxiety and insecurity. The concept of “Living Will” recently approved by the Supreme Court is the window of opportunity for every one of us to initiate our own personal dialogues about death and dying.

I had this intense desire to control everything…over-plan and over-think…predict the future, plan for the worst scenario and when things did not work out as planned I became anxious. I craved security and certainty. And then palliative medicine happened…I saw how uncertain the promise of tomorrow is…how uncertain the practise of medicine is…how life could change in an instant. I learned the art of controlling the controllable while managing the uncontrollable. I learned to go with the flow, take each day as it came. While I still continued to over-think and over-plan, I also learned to groove to the rhythm that life offered. As I embraced the uncertainty the anxiety started to ebb.

Dying well must be preceded by living well, and living well must be predicated on dying well. Thus life and death are unified in the wheel of life.” Paul T P Wong.  I have seen dying patients regret the lost chances, the unfulfilled dreams. I have seen them carry their angst to the grave, distressed and burdened by it. Why do we wait till death comes knocking to realise the dreams and heal the angst?

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I decided to start putting my life together.   I am slowly learning to let go of the hurts.   Instead of living a life dictated by the others I am learning to live for myself. This journey has not been easy…balancing duty with desire, freeing oneself from the bonds of expectations…but in doing so I have found myself. I make time for those healing connections that I cherish; within myself and around me. I live in the moment…I make memories…doing things that I enjoy, with the people that I love. Just as I embraced uncertainly I embraced my life…fully, completely, the good and the bad.

Can any conversation about death and dying be complete without God? If I find Dalai Lama’s “My religion is very simple. My religion is kindness” inspiring; Pope Francis’s “It is not necessary to believe in God to be a good person. In a way, the traditional notion of God is outdated. One can be spiritual but not religious. It is not necessary to go to church and give money – for many, nature can be a church. Some of the best people in history did not believe in God, while some of the worst deeds were done in His name” resonates within me. Need I say more?

While my journey towards spirituality started with a religious orientation, today Hinduism for me is just part of my social identity rather than a belief system. For someone from an orthodox Brahmin family, who woke up to the chants of Venkatesa Suprabatham and Vishnu Sahasranamam, for whom rituals and prayers were a daily routine, this is akin to blasphemy. My spiritual journey has evolved. True compassion is my religion and acts of empathy and kindness my prayer…my work is my solace…I find my peace here, a peace I sought in vain through prayers and visits to holy places few years ago. One of the enlightened minds I met during my journey in palliative medicine, Nani Ma of Ganga Prem Hospice in Hrishikesh, summed this up for me beautifully when she called me a “karma yogi” for whom right work, done well is a form of prayer.   Hindu texts describe three means to spiritual liberation jnana (path of knowledge), karma (action) and bhakti (devotion)…for each his own path.

An enquiring mind wants to know why…medical science seeks evidence. I looked through studies that discussed the neurobiology of compassion. Compassion resides in the anterior insular cortex, the centre of “social brain.” Acts of compassion activate areas of brain that is responsible for happiness and reward (caudate nuclear and anterior cingulate).   The love hormone oxytocin is released when we act compassionately. This hormone reduces stress response including anxiety and contributes to relaxation, trust and psychological stability. All the more reason to practise compassion in this chaotic world!

When you deal with suffering, death, and dying you realise the fallacies that we propagate…“Do good and good will come to you.” Not necessarily. Believe me there are no hard and fast rules in life. Life can be unfair.   Life has many surprises in store for us; some good, some bad. We need to accept what happens and learn to deal with what comes our way. “Hard work does not go unnoticed.” A lot many times it does. Not being given credit for your work, feelings of isolation, lack of respect and subtle bullying makes one think, “Why am I doing this?”

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People work for money, power, fame, and position. When this is threatened there is chaos within them and around them. If you are working for accolades then you are dependent on others for your growth. For me work brings meaning, purpose, peace and growth. When the source of motivation is within you what happens around you does not matter. I survive because the fire within me is burning brighter and stronger that the fire around me…the challenge is to keep that flame going.

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What shines through in all this is the resilience of the human spirit, that though traumatised still has the strength to find a balance. My patients have been my teachers. I have learned from them that suffering is a challenge worthy of investment and engagement and that there are resources within oneself and without that will help us cope with these demands. I have experienced a heightened sense of gratitude for each day that I have, never mind the imperfections, and a deepening faith in the strength of the human spirit. I have paradoxically been enriched, found the stillness amidst the suffering. I have learned to laugh, to cry, and to live from the depths of my soul. In trying to heal others I am on the path of healing myself.

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And as I return home, I see the faces coloured in different hues… the red, blue, green, purple, white, black merging with each other in harmony, celebrating Holi. I see moments coloured in different hues…love, passion, sadness, suffering, hope, dignity, peace, distress merging with each other in harmony, celebrating Life.   As I reach home and step out of the car I am humming… “Rang Barse.” Time to celebrate the Festival of Colours…time to dance, eat and make merry! Only I am singing a little louder, grooving a little wilder…

Depressing or not, my dear readers, it is for you to decide…

(All pictures sourced from google for representational purposes only)

 

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Finding the Balance…a self-reflection about caring for the dying – Part 1

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Today is Holi, the festival of colours, the victory of good over evil. The streets resound with the beating of drums, people dancing in abandon with colours adorning their faces. I am on my way to work, taking in the sights and sounds of celebration, the riot of colours on the street, with a smile on my lips, a song in my heart.

Humming to myself I enter my workplace…Rang Barse…

I see Saurabh sitting in his bed…busy texting and chatting with his friends on WhatsApp. He looks up as I enter and smiles, we wish each other “Happy Holi”. Saurabh is 16 years old and from Kolkatta. He has blood cancer that cannot be treated. He is with us for a non-healing wound in his thigh. His father looks up and smiles. I can sense the distress behind that smile. The father follows me to my cabin. We discuss about the disease and the further plans once he goes back home. He talks about his 10-year-old daughter, his wife and his elderly frail mother. Eyes brimming with tears he rues, “ Mera beta ab to do chaar din ka mehmaan hai (My son’s days are numbered). What do I do about those left behind?” He had sold his land and house for Saurabh’s treatment. Now penniless, with no job, he worries about the fate of his family. He is crying…I am sitting silently across him…his pain resonates within me too. After few minutes he regains his composure, “Who has to go will go, I need to live for those left behind.” Smiling through the tears he thanks me and moves on.

In the next bed lies Shaurya from Mumbai. An 8-year-old with thalamic glioma, a cancerous growth in the brain. For the last 20 days this has grown so much that now he is comatose. A tube goes into his stomach through the nose to feed him, another tube, a urinary catheter, collects his urine. His distraught parents are at his side, waiting for him to respond. As I approach his mother looks up at me hopefully and says, “He is moving his limbs a bit.” I know she is expecting me to say he is getting better. I sit across them on the bed, clarifying that this movement is not a sign of recovery. Again there is silence…the distress palpable, I can feel it. I sit with them for some time discussing our plans of sending him home. They want him to die at home. His father talks about Shaurya a few months before diagnosis, his likes and his passions. He opens his wallet and shows me the picture of a healthy Shaurya, a chubby boy with a smile lighting up his face. He is crying, his wife sobbing, my eyes are brimming with tears. I find dealing with children extremely tough.

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In the next room is 55-year-old Shobha. She has cancer of the gall bladder that has spread to her liver and her intestines. Her intestine is blocked (obstructed) because of the cancer. She has been admitted for intense pain, which is currently under control with medications. She has a tube running from her nose into her stomach, what we call a nasogastric tube, which drains contents from her stomach. She is comfortable today, smiling as I enter. She applies a tika on my forehead for Holi and wishes me. Her husband and son are by her side. It is their wedding anniversary today. Her husband is with the armed forces. A major part of their marital life had been spent apart, he serving the country, while she looked after the home and children. They were hoping to spend time together after his retirement in three months time…and had even planned a vacation. He is dreading going back to an empty house. As I wish them I can sense the despair writ large on their faces.

Amrita is a 48-year-old with breast cancer that has spread to her liver, lungs, bones and brain. She was brought with convulsions and agitation. Her seizures under control, she has what we call “terminal delirium”. When she is awake she is disoriented, aggressive, not recognising her family. We have sedated her to control her symptoms. He son and daughter sit by her side, waiting for an end to her suffering.

Then, there is Hussain and 30-year-old from rural Maharashtra. As I enter his room a sickening odour invades our senses.   Hussain has oral cancer. A huge wound has eaten away half his cheek and neck. This wound is filled with maggots. His wife has left him, his siblings don’t want him, and his elderly mother is unable to manage on her own. He has no money for medicines or food. He lies helplessly waiting for the health professionals to solve his medical problems and for the social worker to find him a place where he will be taken care of.

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These are some of the patients I see every day. The faces change, the diseases are different, but their suffering universal…that of patients and families coping with the primeval fear of death and disease.   I witness this distress of the body and the soul every day. I am a palliative care physician. For those of you not familiar with the term palliative care, it is that branch of medicine that looks after patients with terminal illnesses. Palliative medicine helps the patients with terminal illness to live as well, as comfortably as possible, right until the end of their lives and to die with dignity when the time comes. It is called comfort care, aiming to reduce the suffering of not only the patients but also their families.

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As I enter my workplace the colours of Holi look faded, the sounds of laughter muted… It is a world of contrasts…Dance of Bliss outside, Dance of Destruction inside!

Often friends and family alike ask me how I work in this “depressing” “difficult” “tough” environment. “You must be very strong” is what I often hear…Colleagues in other branches of medicine assume I deal with this by being “objective” or that “one gets used to it.”

These questions set me thinking…Indeed how do I work in this environment? How does any one work day in and day out in this environment and not be affected by the suffering of others? How do we, those working in palliative care, cope?

“When we stand on the low rungs of the ladder of sorrow we cry. 

When we come to the middle we are silent                                                           

But when we climb to the top of the ladder of sorrow, we convert the                    sadness  into a song.”    (Ancient Hebrew Poem)

The next part on how I find the balance will follow shortly…

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The Chaotic Mind

Today is World Mental Health Day…My tribute to those who have mental illness and have to constantly live with the stigma of the illness. Two young patients in their late teens consulted me today. I guess this poem written by me is a reflection of that consultation. 

Untethered on the edge I wander- 

of forced normality

Lured by what lay yonder

My irrational reality

Spiraling into a chaotic world

Of swirling, storming gray 

Where things were how they were not

A mind in constant disarray

Where malevolent shadowy people

Haunt my waking world

Where incessant voices of evil

Echo unseen, but not unheard

Where my moods have lost their rhythm

And my words fail to rhyme

And as my mind slips into a schism

What reigns is pandemonium

Am I a visitor in this path

Or forever destined to stay

And as the carnage rips me apart

Am I cursed till my dying day

Teetering on the edge of insanity

I view the world askance

As the sane world, your “fictional” reality

Points fingers at me, takes a “noble” stance

Amidst this I yearn…

For a second of sweet silence

For a night of unhaunted sleep

For a day of unfettered freedom

For a moment of serenity

And a lifetime of pure sanity

Commentary:
Stanza 1:  Forced normality: People do not understand the signs of mental illness and they force those affected to be normal. Irrational reality: Though the thoughts/feelings/beliefs of a mentally ill person may seem irrational to the outside world, for the patients what they are very, very real 

 Stanza 3: Malevolent shadowy people: Visual hallucination the ill-person experiences

Waking world is the person’s conscience

Incessant voices of evil: Uncontrolled auditory hallucination

Moods losing rhythm: Normally one’s mood are in congruence with one’s thoughts. In mental illness the poetic dance between our moods and thoughts is lost. For example a person may think that someone is trying to kill him, but may laugh while saying this

Words losing rhyme: People with mental disorders lose clarity of thoughts and expression. In medical terms this is called as formal thought disorder

Schism: Means splitting of the mind

Stanza 4:  The patient is asking if she will get cured or is this going to be a chronic problem

Stanza 5:  Speaks of stigma of mental illness. Even normal people perceive reality differently. What I think of a situation, another person may not think the same. In essence every reality is created by our mind, i.e. it is fictional.

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Quest for freedom on Independence Day

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                  Happy Independence Day!

With pride I watch, like every other Indian, the unfurling of the tricolor and the celebrations on the 71st Independence Day. India celebrates her birthday, her liberation from the largely perceived as “oppressive and repressive” 200-year colonial British rule. India has galloped ahead since those times, the naysayers notwithstanding, more so in the last decade. And in my mind questions abound –While India the federal union celebrates her freedom, are we, the people of India, truly free?

When we stop judging a woman by the length of her skirt or the color of her lipstick…when the birth of a daughter is revered as much as that of the son…when she can belong to her workplace as much as to her kitchen…when she can walk as freely on the roads during the night as in the day…when instead of chipping her individuality to mold her into “what she should be,” she is given wings to explore “what she can be”…when instead of protecting her, she is given a choice…that is when we, the people of India, will experience true freedom.

When what I eat is dictated by taste, not caste…when what I wear is decided by choice, not religion…when every Indian sings the national anthem with pride…when the law of the land, instilled in the Constitution of India, will reign supreme for one and all…when the religion is practiced within the four walls of the house…when repressive diktats and oppressive fatwas find no place in public conscience…when there is a distinct separation between organized religion and state…when the Indian in us rises above fault lines of faith, regionalism and linguicism, only then can we, the people of India, experience true freedom.

When the streets are as clean as our homes…when the child on the road reads like the one in the home…when universal healthcare is no longer a pipe-dream…when “retail corruption” is a thing of the past…when the politics of quota and reservation becomes obsolete…when “sabka sath sabka vikas” is not just a slogan but a reality…only then will we, the people of India, experience true freedom.

We, the people of India, will experience true freedom only when we succeed in shrugging off our cloak of indifference. Isn’t it always “their” responsibility…Aren’t “they” to be blamed for everything…As long as it does not affect “me” why should “I” get involved. This habit of blaming the abstract entity, the determined apathy…is this a coping mechanism, a fatal fatalism, a pervasive loss of hope, or just a pass-it-on attitude…what drives this, I wonder? “The world suffers a lot, not because of the violence of bad people, but because of the silence of good people”, said Napoleon. The good people of India are guilty of silence allowing the ranters and ravers a free reign. The interpretation of freedom as being able to say and do whatever one wants, without respect for the law of the land or the right of another, is a surefire recipe for disaster in a pluralistic society. “Freedom and power bring responsibility,” said Jawaharlal Nehru. When freedom of speech is tempered with freedom of thought, i.e. awareness and understanding of a situation, along with the ability to choose the “right” response, both individually and collectively, only then will we, the people of India, experience true freedom.

We can call ourselves a truly independent and free country, as guaranteed by our Constitution, only when we free ourselves from our oldest curses…our misogynistic attitudes, divisive religious belief’s, and our determined apathy. Are we ready for this challenge, another struggle for Independence, this time not from the colonial rulers but from our own “oppressive and repressive” attitudes I wonder?

 

 

 

 

 

 

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The angst of a woman…

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I am “janani”…the mother

I am…so you are

I carry you in my womb…

Give birth to you…so you are

Yet, I’m cursed…

My womb abused…

To have birthed…

The monster in you…l

I am…a daughter

You are…so I am

Created by you…so I am

Yet, I’m cursed…

Killed in the womb…unwanted, a “bojh”

If born, a “paraya dhan”…a “thing”…

My existence cursed…

To be owned by one…handed over to another

I am….”ardhangani”…your better half…

I am…so we are

I carry your future…your heir

Yet, I’m cursed…to oblivion

To be seen, not heard…

Within the four walls of your home…

To serve, but not demand…

To exist, but not live…

I am… “sthree”…the woman

The yin to your yang…

Two halves that make a whole…

But this one-half is cursed…

Cursed am I…

By your inappropriate touch…

By your acts of wanton lust…

By your abusive words…

And hands that are raised to hit…

Cursed am I…

To carry the burthen of impurity…

To be exploited with impunity…

The ignominies heaped upon me-

Condoned by all as the way to be…

In the shroud of “honour” buried to lie…

My hopes and dreams under the starless sky!

I am “Shakti”…the energy divine,

Worshipped by you, yet curtailed in a shrine,

Unfettered one day…I hope to rise again

From the ashes of bigotry, enriched by the pain!

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Two Souls…

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Two Souls

Feeling…

Two souls

Not hearing, not seeing

Just feeling

The travails of the broken heart

Chained together, yet wrenched apart

(The two souls here are the patient and their loved one…they do not hear  norsee the normal activities of life once diagnosed with cancer. They just feel the pain, the suffering the disease brings. Chained in their suffering, wrenched apart by destiny)

Two Souls

Wandering…

Not caring, yet daring

Just wandering

Along the eerie broken path

Dodging the fiery hands of wrath

(The normal path of life broken, the two souls walk a lonely, ghostly path. They don’t care about the fear, with great strength they try to dodge death (fiery hands of wrath).

Two Souls

Seeking…

Not knowing, not speaking

Just seeking

Solace together, arm-in-arm

The stillness amidst the storm

(The two souls seek comfort in each other, not knowing how the disease is going to progress. Most patients and relatives do not talk about their disease to each other or anyone else…in all the storm (upheaval in their lives), they seek stillness (peace)

Two Souls

Resting…

Not running, not jostling

Just resting

In their secret sylvan place

Bleeding hearts, at last in peace

(The two souls when they stop running from the truth (when they overcome their denial), when they stop jostling i.e. pushing for futile treatments; when they accept the inevitability of death, at last find peace. By secret sylvan place I mean coffin.  Their heart bleeds at the thought of losing loved ones, but still they find peace)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The pain that the rain brings…a malady of craters

My childhood memories…two sturdy bullocks with bells round their neck, tethered to a colorful rickety wooden cart with two large wooden wheels, driven by a scrawny turbaned driver, with betel juice staining his mouth. The reins of the cart in one hand, he cracks a thin whip with the other, much like a magic wand onto the back of the hapless animal. With a sudden jingle of bells the cart starts to sway forward…all of us in the cart in for a bumpy ride over the unpaved roads, the sun beating down on the face, the cool gust of wind ruffling the hair…an unique experience, reminiscent of the years gone by.

And then there was the sleepy town of Bijapur where I went to medical school, known for the famous “Tanga”, the horse buggy, this our preferred mode of transport. Drawn by an emaciated, ill-fed horse, the creaky carriage would carry quite a few of us. I am ashamed to say oblivious to the concept of equine abuse at that time we would enjoy the tanga ride. At times the more adventurous amongst us would take over the reins from the driver and with a whoop and flick of the whip propel the carriage forward. As the horse raced clickety-clack, with our hearts in our mouth, we would silently pray to reach our destination in one piece.

Of late I have been reminiscing a lot about these bumpy rides, more so after coming back from sunny London to a wet, wet Mumbai. The week I landed there was heavy rains. My car decided to try swimming in the pool that came up overnight outside the house. Needless to say, she drowned. We tried to rescue her, but alas she had ingested way too much water. She has since been admitted at the local garage for the past few weeks…to recuperate…the organ transplant is taking its time…

Life has been an adventure ever since as I negotiate the Mumbai roads in a cab or an auto. All adventure enthusiasts from around the world would agree with me I am sure. The fantastic adrenaline rush you get has to be experienced to be believed!

The looping, twisting, whirling experience has left me enthralled. With a loud roar the rickety beast (rickshaw) jumps to life to negotiate the pock-marked road, just like the horse-buggy. As she races ahead she sways from side-to-side, at times lurching forward, at other times backward, and I hold on for dear life. As the ride gains momentum, I find myself floating weightless upwards, defying gravity, only to land with a loud thud onto the hard seat. Each death-defying plunge leaves me breathless, physically and emotionally depleted. As I reach my destination battered and bruised I say a silent prayer…at last I have arrived. The cab rides are a bit smoother…much like the bumpy rides on the bullock carts. The drives skilled, negotiate these craters with the experience of a rally driver… You are shaken and stirred and thrown around all at once, leaving your osteoporotic bones aching and the arthritic joints creaking.

It’s a known fact that the craters on Mumbai roads are bigger and better than those on Moon or even Mars.   And as some news report states NASA is tying up with amchi BMC to train all astronauts on the crater-ridden Mumbai roads!!

As Winston Churchill said, “If you are going through hell, keep going”, the journey of every hapless Mumbaikar during monsoon…and as we struggle our politicians and BMC have much more important work to do…renaming roads, reforming the culinary habits of Indians, designing appropriate dress codes for women, etc…

mumbai-road-pot-holes-are-like-moon-craters

Pictures are sourced from Google, from India Opines

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Picture sourced from Google

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