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My heart writhes in agony

My mind is numb with pain

At the unfolding tragedy

That I witness yet again

Gasping for a breath of air

My beloved land is reeling

As deprived of appropriate care

Thousands today lie dying

The Reaper has gone berserk

Wielding his scythe unrelenting

On the young, the old, alike

The onslaught never-ending

The terrified ghastly cries

Of those living the ordeal

The incessant raging pyres,

Haunting visions, so surreal

The guilt in those left behind

Of the unread last rites

Torment the grieving mind-

These unsung goodbyes

My heart writhes in anguish

My mind seethes with anger

As I watch humanity languish

In the throes of political rancor

The shrill voices of dissent

The jingoism of the ruling breed

The inept governance

The inexorable human greed

Left, right or center

The ruled, the ruling together

Feasting on the lost souls

For selfish, hedonistic goals

In all this I pray,

For my beloved land to heal

To emerge from this crisis

To work together with zeal

To neutralize this raging virus

For my beloved land to breathe-

The air of unity, beyond the division

For those that come after to bequeath-

A legacy of hope and compassion

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As I looked into the mirror

I find a new me

My image a lot clearer

Than what it used to be

 

Cloaked in another’s color-

I did betray my real self

Living the dream of another

I did bury my innate self

 

Lured into a cocoon of safety

I lay bent, out of shape

Retreating from my authenticity

I lay trapped, beyond escape

 

Sounding aloud a bugle call

The raging tempest blew past

Alerting my insipid soul-

That watched life’s betrayals aghast

 

Skirting the abyss of loneliness

I reached out for help, in vain

As those feasting upon my kindness

Gifted me a lifetime of pain

 

As those hands holding my heart

Dropped it, with no further thought

And its shattered, sharpened shards

Tore open the cocoon’s innards

 

Freed from the despairing darkness

Like from the cocoon, the butterfly

I found healing in forgiveness

And my place under the sky

 

Where I embrace each searing hurt

With the strength within my heart

Assimilating each pain within

A new journey I begin

 

Swathed in hues of my own

The darkness long since gone

Turning my pain into compassion

I see rainbows in the horizon

 

And this time…

As I look into the mirror

I find a new, improved me

My image, a lot clearer

Than what it used to be

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I can see your suffering
I can feel your pain
As I find you writhing
In distress yet again

I can smell the bile
That rises up your throat
See-through the beguiling smile
Hear each discordant note

I can hear you gasping
Each strenuous gulp of air
Your every breath so rasping
Fills me with despair

I can see the questions
In your desperate gaze
As you seek redemption
From your drug-induced haze

I can sense the desperation
In your loved ones face
Hope shattered in consternation
The uncertainty they embrace

I can see the stoic faces
Hands that are skilled in cure
The incessantly beeping machines
Invading, inflicting for you to endure

I can see your eyes relentlessly searching
For a loved one each passing hour
I can see death stealthily approaching
And I wonder, is there no succor?

And then I see the lone crusader
That seeks to heal, not cure
Withdrawing, withholding procedure
Gives succor like never before
For whom death is not a stranger
But an inescapable truth of life
Who heals your pain, soothes the strife
And lets you go with your loved ones near!

The Pandemic

Picture sourced from google, used for representation purpose only. Picture source credited to: https://www.technologyreview.com/2020/03/12/905352/ai-could-help-with-the-next-pandemicbut-not-with-this-one/

The world falters, under its relentless siege
The mind quivers, with fear, besieged
This modern-day scourge, this enemy unknown
Has sneaked into our homes, unseen, unbeknown

Across each continent this endless rampage
Is raging unfettered causing irreparable damage
Confined to homes, normal life disrupted
Human existence threatened, lives interrupted

Millions are living in despair, desolation
Enduring the vagaries of unjust isolation
Grappling in the throes of insatiable hunger
Their livelihoods lost, their lives ripped asunder

Thousands are dying, an untimely death
Gasping in vain for life’s elixir of breath
Hooked on to ventilators, bereft, forlorn
With no loving goodbyes, no funerals to mourn

Raging within is yet another pandemic
A malady of the human psyche, so endemic
Hatred and bigotry sneaking into each Soul
This contagion of spirit seems beyond control

Felled, in the name of the God, or by the color of the skin,
By the language spoken, or by the land lived in
Fuelled by inequity, injustice, intolerance
These man-made plagues haunt human existence

Battling their fears, the incessant plunder
Few valiant ones keep fighting, refusing surrender
Donning chance’s armor, braving the odds
Dodging the Reaper, relentlessly they plod

Restoring lost dignity, igniting new hope
Amidst the chaos, new strengths to cope
Healing this world with compassion and love,
Restoring humanity, faith in the power above

When we all have to but perish one day
I wonder, what is this digression that’s led man astray?
As each one is felled by this deadly dance of death
I ponder, what gives life meaning, value to each breath?

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In the chaos of life, it’s a faithful friend

In life’s never-ending strife, it’s something to befriend

In the deafening cacophony, it’s a moment of quiet

In the suffocating hegemony, it’s a moment of respite

 

In its vast emptiness, I taste the essence of my soul

In the moments of nothingness, I find life’s ultimate goal

In its deafening silence, I hear the symphony within

In its calming stillness, I seek a new beginning

In its soothing darkness, life’s blessings abound

In its blazing flame, I experience peace profound

 

In its warm embrace, I find hope and fortitude

In its gentle touch, my inquietude lies subdued

In its presence mere, my wayward Soul is healed

In its promised path, life’s truths lay revealed

 

Solitude and me, in as much harmony as we can be

Self-compassion and self-acceptance, the magical key

That fill up the cracks in the depths of my Soul

To merge the fragmented parts into a universal whole

For as much is lost, there is much more to gain

As with every pleasure, there is an edge of pain!

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I can see your suffering
I can feel your pain
As I find you writhing
In distress yet again

I can smell the bile
That rises up your throat
See-through the beguiling smile
Hear each discordant note

I can hear you gasping
Each strenuous gulp of air
Your every breath so rasping
Fills me with despair

I can see the questions
In your desperate gaze
As you seek redemption
From your drug-induced haze

I can sense the desperation
In your loved ones face
Hope shattered in consternation
The uncertainty they embrace

I can see the stoic faces (of many a great doctors)
Hands that are skilled in cure
The incessantly beeping machines
Invading, inflicting for you to endure

I can see your eyes relentlessly searching
For a loved one each passing hour
I can see death stealthily approaching
And I wonder, is there no succor?

And then I see the lone crusader
That seeks to heal, beyond the cure
With soothing words, gentle touch
Minimal drugs, and low-cost tech
Provides the much-needed succour 
For whom death is not a stranger 
But an inescapable truth of life
Withdrawing, withholding procedure
Lets you go in peace, with loved ones near!!

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I strive to heal

The fragmented parts

Of my anguished soul

As Life’s poisonous darts

Puncture a hole

And rip it further apart

I strive to smile

Despite the loss

Of dreams worthwhile

As I trudge across

Each bloodied mile

With the scarlet Cross

I strive to gather

The shattered fragments

Gluing them together

The unjoined segments

So as to weather

The endless torment

I strive to live

Through the pain

Trying to relive

Life’s promises again

Choosing to believe

In the flowers after the rain

By

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My struggle is…

Between the thinking mind

And the feeling heart

That is never in harmony

Forever apart

Between the outer conditioning

And the inner calling

Is a tussle unending

In a world unrelenting

I ponder…

Between the clutches of duty

And the flames of desire

Is there a future full of beauty

Or a trial by the fire?

Between the need to live

Or to merely exist

Do I forever forgive

Or attempt to resist

I attempt…

To find in the stoic silence

A meaning for my existence

In the world of pretence

A moment of relevance

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.

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.

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.”

        

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?”

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.

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?

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?”

    

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.

               

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.

                    

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)

 

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

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.

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.

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.

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…