Wading Through Quicksand (Palliative care, Spirituality and Sanatan Dharma)

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.

Dr. Abhijit Dam had his training from All India Institute of Medical Sciences and Masters in Palliative Medicine from Cardiff University in addition to certification in advanced Vedanta, Care of the Elderly and Contemplative practice in end of life care. He has extensive experience in the fields of Anesthesiology, Critical care medicine, Pain medicine and Palliative medicine. He is a National faculty of the Indian Association of Palliative Care. He has been associated with KOSISH which is a NGO providing palliative & supportive services in Jharkhand, Bihar & West Bengal. His current passion is developing a Long term care facility for the Elderly and terminally ill providing holistic care, which is nearing completion. He lives in Bokaro Steel City, India.

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 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.