Thread by @sohinichat

This week I had a conversation about end of life care with a physician. I've been thinking about it for years but unable to implement it as there are barely in doctors in Calcutta who talk death without intervention.
The few who do, do palliative care for cancer patients ++

Conversations about end of life care, in my experience, bring an uncomfortable silence, which carries the accusation that I am enabling the death of my patient, passive murder.
But the pandemic truly underlined the paucity of hospital beds in India. If an 80+ years old patient +

who has articulated a wish for a gentle death without intervention falls ill, why should they take up an ICU bed? It's a criminal waste of resources! Yet ERs in private hospital assign ICU care to geriatric patients as a matter of routine!
Geriatric care specialists are scarce +

And the couple of such specialists in Calcutta refuse to do remote care or home visits. I guess they are overburdened with patients.
So it was a huge relief to have a conversation with a doctor about a gentle death without hospitalisation without being made to feel guilty ++

I felt a stone being removed from my chest region. And then the conversation with the doctor who came home to see my grandfather: a thoughtful listener who remarked that hospital care sends back patients like my grandfather with a bedsore. Indeed, the last time my grandfather ++

was hospitalised (in 2019) in one of the city's most reputed and oldest hospitals, he came back with a bedsore. I can't tell you how comforted I feel that I could have this conversation finally. It took me half a decade. In the 2019 hospitalisation, the doctors insisted on ++

a nasal-gastric feeding tube for my grandfather because he was unable to swallow. I had to insist on a PEG tube because the discomfort of having a tube through your nose and throat constantly is quite evident. But not to them. Felt like a battle. But it shouldn't be like this ++

Hospital deaths are horrible. In addition, private hospitals seem to have a panic about a death on their hands even if it is that of an octogenarian. So they seem to insist on invasive treatments and then send patients home when they seem like a losing case.
My family has no ++

idea about palliative care or end of life care either. Their idea of palliative care is homeopathy followed by a last minute panic hospitalisation. They did this for my mother's mother despite my making the effort to go to the Tata hospital and coming back with a recommendation +

for palliative care. I don't blame them, although I do feel angry that they chose to disregard my work. My grandmother had a horrible death. Panic hospitalisation followed by panic discharge followed by sudden death at home.
They don't know and it is like easy to disregard the +

views of the daughter of the house. The reason they don't know is the lack of public discourse about palliative and end of life care. Doctors don't talk about it. Hence this space is taken up by homeopaths and naturopaths and ayurveds.
Doctors seem to feel death is failure ++

But a gentle planned death is the opposite of failure. By gentle, I mean as gentle as the coming and leaving of life can be
If death is a failure, then everyone is a failure. God too, for those who believe
Huge thank you to Dr Rajani Bhat + Dr Shrikanth Atreya and Dr S Sinha ++

you really are doing god's work on earth. I am not a believer but your thoughtfulness makes me doubt my atheism a bit. Inching toward agnosticism now @RajaniSurendarB