Day 1

2:30am:

I am stepping off a flight in New Delhi. Air is chunky and warm, overpowering me with its familiar smells.

I’m living the mundane life of an arriving passenger — navigating the pesky walkways and phone issues, to find my Uber driver.

I hear what sounded like military jets in the air. Dismissed it.

8:00am:

Called my brother. Asked him how things were. “Every hour he is deteriorating”, he said. Trust my brother to lay it out succinctly, as always.

I’ll see you in the evening, I said.

8:00pm:

2 flights later I am in Kerala — a thousand miles South of Delhi.

During the flights, I learnt that 40 Indian reserve military men were killed by a suicide attack in Kashmir a day ago.

I recalled hearing the military jets in Delhi. The country was in mourning. Soon we’d follow.

I scan the arrivals for a ride from the airport. Wishful thinking!

For 30 years, it had been my brother-in-law who would always pick me up cheerfully. Not this time.

9:00pm:

I am at the Regional Cancer Center in Thiruvanathapuram, Kerala.

I see him finally — my brother-in-law, the laboured breaths, the slow drips of the IV. Other circumstances would have had me joke about Chinese water torture. Here drops were succor.

The Crab had encircled his lungs and vertebrae — his cage constricted, limiting his ventilation. Every breath was a willful act of courage, seemingly under water.

Juxtaposed in that hospital-room was what cancer can do to a loved one and what modern medicine cannot do.

That’s when I met Sanju. Dressed in gray shorts and a blue half-sleeve shirt, he was the in-room nurse. Sanju was in his twenties, pleasant and upbeat — incongruous under the circumstances — but soothing and quietly efficient.

As I watched him attend to the patient, I noticed that caring seemed to come to Sanju naturally. Extreme human suffering was a thing he took on with equanimity, it appeared.

What made him choose a career path like this, I wondered. Did he have a mentor or career counsellor who influenced it? Unlikely. He seemed to divinely glide into care giving.

Later, I remember him tactfully dissuading us from straining the patient with our well-intentioned presence.

Called it a night. The sea breeze was merciful in the hot and humid late-night. Never found sea air as teary.

I took out my own palliative medicine — my sombre music list fed to my brain. Songs from many languages curated for their tempo, timbre, and tone. They all sounded the same to me.

Bist du bei mir… If you are with me, then I will go gladly unto death and to my rest…

Was the record player in my brain stuck? Or did every song in every language in my melancholic collection, when stripped of its ornamental glory, convey the same meaning? Or was my cognition and jetlag playing late-night tricks on me?

Day 2

Back at the hospital, the drumbeat of the IV drips has accelerated.

Morphine on steroids…I reflected morbidly. The faster they drip, the slower the breaths get, until…breath becomes air.

The treatment is all on plan. We are not on any futile, rescue-care pathway. Not on some magical curative pathway. This is end-stage comfort care — palliative only.

And to think that just a year ago, him and I were celebrating him overcoming a stage-4 cancer spectacularly… never mind! This ain’t the time for what-if’s.

I observed from the chair next to the bed how Sanju cared for my brother-in-law. He called him “Achan” — the local language word for Father. He was gentle and persuasive, making sure the patient was comfortable, anticipating his needs. He was an all-rounder — a nurse, family caregiver, and a good waiter. That’s beyond clinical services alone!

Sometime that afternoon, my brother-in-law recognized me. He took my hand. Attempted to say something. He could not. He had already said it generously last week on WhatsApp, when he was more able.

Even if he had said something, we couldn’t have heard it.

For, in that instant, all around the building, a Kerala temple-procession broke out with the vigour of local drums (“chenda”) — as if the Arabian sea sighed and slammed tumbleweeds on to the building noisily.

A benediction of nature for an auspicious good bye?

Day 3: Devotional Service as The Way of Life

Morphine marched faster.

Sanju came back from his break with his father and mother. We talked about their home town — a place close to where my home was. Them three seemed to be completely at ease with the situation in front of them. Without any overt expression of concerns, they seemed to be in the groove of what needs to get done — the groove of being in service with compassion.

I found out that Sanju’s father was a member of the national reserve military force bombed by terrorists. I offered my condolences towards his lost mates. He stared ahead, avoiding my eyes. He could not hide in his steely eyes his pride and dedication to national service.

I went for lunch. Cafe was crowded and spartan. The staff made sure I got everything and was served well throughout my meal. Is the universe just being extra nice to me? Why is this focus on service so striking?

Perhaps I forgot, having not lived in Kerala for 3 decades. It seems to be the norm here. Whatever you ordered, and whoever you are, you deserved to be served right. No exceptions!

Back in the room. I had missed the doctor’s rounds.

Doctor’s orders: Time to bring close family back. We all assembled by evening one last time.

We encircled the bed, as if to provide a human palliative cocoon in addition to the chemical cocktail in the bloodstream…or so I hoped.

Then we withdrew, leaving one in charge for the night.

Epilogue

The nightwatch ended in the wee hours of the morning.

I flew out the next day. The Crab had its day for now in Kerala, just like terrorists had in Kashmir. I had witnessed acts of service with compassion and devotion.

Flying back to San Francisco, I carried the weight of an infinite sense of gratitude, duty-free.

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