Wading through quicksand: Palliative care, Spirituality & Sanatan Dharma

By Dr. Abhijit Dam

After my long years of practice in the field of critical care medicine (since 1993) and disturbed at the state of lonely, painful and undignified deaths that patients face, I embraced palliative medicine in 2006.....working closely with the dying and their families made me reflect upon the unknown facet of spirituality and its close associate, religion. I practice mostly in situations that people frown upon....marginalized population in rural and tribal settings in some of the most backward regions of India.....though I did have my share of working with all luxuries, including ready access to morphine.....Let me make one thing very clear....morphine alone cannot cure pain....so even if morphine is available, the scenario in which I am working will not change much! I had recently volunteered to work in a hospice in Rishikesh where morphine was freely available and I did not feel that it made much of a difference. The question to those of you (privileged ones) who work with morphine is “Can you work without morphine”.....and THAT is the challenge.

Addressing SPIRITUAL and RELIGIOUS issues is the key! That is what I have learnt from ground zero...repeatedly...without fail....medications do have a role no doubt, but small in comparison.

This tempted a strong atheist like me to take a peek into religion and I completed a course on Vedanta, which is the backbone of Hinduism.....and then into Buddhism....compassion....and I am still on the path....its bliss for sure....and there has been no looking back....

I even brought out a small handbook on 'Spiritual issues in the last days of life....a perspective of Sanatan Dharma' , which I have incorporated here.

Tat tvam asi.

• Language: English
• Publisher: Notion Press
• Release date: Jan 29, 2015
• ISBN: 9789384878320

Book preview

Wading Through Quicksand

Palliative care, Spirituality & Sanatan Dharma

Dr. Abhijit Dam

Notion Press

5 Muthu Kalathy Street, Triplicane,

Chennai - 600 005

First Published by Notion Press 2015

Copyright © Dr. Abhijit Dam 2015

All Rights Reserved.

ISBN: 978-93-84878-32-0

This book has been published in good faith that the work of the author is original. All efforts have been taken to make the material error-free. However, the author and the publisher disclaim the responsibility.

No part of this book may be used, reproduced in any manner whatsoever without written permission from the author, except in the case of brief quotations embodied in critical articles and reviews.

The proceeds from the sale of this book would go towards the advancement of palliative care, including the care of the elderly.

Dedication

I dedicate this book to my wife and children who have patiently borne my whims and fancies

I alone cannot change the world, but I can cast a stone across the water to create many ripples.

Mother Teresa

Preface

In today’s fast-paced materialistic world, the individuality of a person is rapidly vanishing. Illness is often dealt with in a mechanized manner with the aid of machines in foreign settings under the banner of ‘healthcare industry’, whose main motive is to generate business from sickness. The sad result is that our loved ones are dying lonely and painful deaths in the intensive care units of hospitals, often latched on to life-sustaining machinery. But then, do we ever wonder if we are giving life or merely prolonging death and suffering? The question which we should ask ourselves is would we like the same fate for ourselves? I often ask my audience ‘where they would like to die?’ and not surprisingly the unanimous answer is ‘at home’! Sadly though, very few of us are going to be fortunate enough to do so, to die at home, surrounded by the people whom we love, holding on to our hands till our souls depart from our physical self.

It is also during periods of illness that one seeks solace in spirituality and religion, apart from medical care But holistic medicine should address the body, mind and spirit; sadly though today’s healthcare professionals are often ill equipped to handle the mind and the spirit. Gone are the days when the wise and friendly family physician used to come down to your homes & treat the ill, apart from discussing other family matters & psycho-social issues over a cup of tea. Individualization of care was a priority & healing rather than just cure of illness was the goal.

Kosish is the first NGO in the tribal state of Jharkhand in India, providing free palliative care to the community. It does so by its group of dedicated & unpaid professional volunteers who give their skills, time & very often money for patient well being. Kosish provides care irrespective of patient color, creed, religion or class. At present it does not have access to donations. It believes in humanity and ensures a dignified, symptom free life until death.

It was during the care process of the terminally ill that the author was often confronted with questions addressing religious & spiritual, issues like:

How will I die? Why me? Will I be reborn? Can rituals save me? Will I go to heaven? Why am I suffering so much? Etc.

The author found this to be a stumbling block in the care process, for none of these issues are currently addressed in the medical curriculum in India. Moreover, working in a community where the majority of patients are Hindus, in India, the author felt that an understanding of some of the basics of Hinduism is a must for healthcare professionals delivering holistic care.

Hence this humble effort.

The author is immensely grateful to his critics & well wishers, who reviewed his work.

Contents

Title

Copyright

Dedication

Preface

1. Palliative Medicine; the Care and the Concept....in India

2. Palliative Care...the Scenario in India

3. Focusing on the ‘Basic Needs’

4. Taking a Proper History...

5. Communication – the Indian Way

6. Optimal use of Available Resources

7. Therapeutic peritoneal taps in resource-poor settings

8. Timeless Life

9. The White Patch…

10. Maggot Infestation – the Ultimate ‘Torture’

11. Impacted and Hard!

12. A Hospice in a Car?

13. FIFA World-cup!

14. Who is Demented?

15. Hitler would have been Ashamed!

16. Fools Never Learn

17. Preventive Palliation in the Elderly

18. The Power of Music!

19. Hospice Tour India: A Report on Palliative Care Awareness in Our Country

20. Home-visits Hold the Key!

21. Working without Morphine…

22. Our Innovation...the ‘Kosish Cocktail’

23. Teachings while Providing Palliation...

24. Indicators to Recognize that the Patient is Approaching the Last 48 Hours of Life

25. Why should doctors focus on spiritual issues?

26. Spiritual concerns in the dying...a Grossly Neglected Issue

27. Dreams…Visions...or Reality of Afterlife!

28. Thus spoke our Vedas...

29. Sanatan Dharma, Death and Dying

30. Buddhahood

31. My Himalayan Sojourn – Doctor Heal Thyself!

32. My Tryst with Religion...and Realising Spirituality

33. Becoming Naked!

34. Fodder for the Mule

35. About the Author...

Palliative Medicine; the Care and the Concept....in India

Even today, in India, when you talk about palliative care, all you usually get are dull vacant looks. Fact remains that most of us are not conversant with the concept of palliation...leave alone the general public, even most of the medical fraternity and allied healthcare professionals do not understand what it stands for. The concept, when explained, is most often given a casual listening to and forgotten almost immediately; you will also come across the pseudo-intellectual who will respond with a thoughtful ‘ah...how nice’ and that is it!

The fact remains that we are happy to