There was a great buzz in the third floor of ‘The Multi-Specialty Hospital.’ A Code Blue had been declared and the emergency cardiology team rushed to room no. 341. A frail old man was being attended to, by the regular doctors. The emergency team took over and after fifteen frantic minutes, calm descended over the entire team. Mr. Shukla was under sedation and apparently the worst was over.
The Superintendent of the Long-Term Care Unit (LTCU) Mrs. Rodriguez asked her assistant to call Mrs. Chopra and inform her that Mr. Shukla will be out of sedation by 7 pm.
Promptly at 7 pm, Mrs. Chopra, a spry looking seventy-year-old, walked briskly towards the LTCU. She felt a sudden chill pass over her body, as if someone was walking over her grave. She looked at the sign board; it blurred and came back to focus after a few seconds. She shuddered and read aloud the inscription in gothic script. “Abandon Hope All Ye that Enter Here” She furiously blinked her eyes and was relieved to see the usual sign for LTCU.
She muttered to herself, “LTCU is not Dante’s Hell. These terminally ill patients are not hopeless. They have me and Hope Foundation rooting for them.” With steady steps, she reached room no. 341. Mr. Shukla was awake. She spent some time with him lifting his spirits. She gave him a bottle of freshly squeezed orange juice as well.
She then slowly walked to the office of Mrs. Rodriguez. They discussed the latest episode of Mr. Shukla’s health condition. It was clear that he was fully paralyzed and practically a vegetable although his brain was sharp. He was suffering terrible spasms of pain. Mrs. Rodriguez in a tone full of sorrow explained, “He has no chance of a cure. He is suffering very badly. But his general condition is excellent. He will live for 20 years more and suffer every minute of it. But the whole team was surprised by his sudden cardiac emergency. After all, the Almighty, who is full of mercy is planning a peaceful exit for him.” Mrs. Chopra nodded soberly.
When Mrs. Chopra reached the headquarters of the Hope foundation, she was met by the Director of the foundation, Dr. Sanjivani. She asked anxiously, “How is Mr. Shukla, madam?” Mrs. Chopra replied,” He seems to have picked up a new problem in his heart. Let us hope for the best”.
Dr. Sanjivani accompanied her as Mrs. Chopra slowly made her way to the office of the Chairman of the foundation and lodged herself into her comfortable chair behind an ornate antique desk. There was an original Rembrandt hanging on the wall directly facing Mrs.Chopra. After her junior colleague left for her own office, Mrs. Chopra reclined in her chair and reminisced.
She could almost sense the presence of her husband Prashant. He was a very successful industrialist. Her family was affluent in its own right. It was a match made in heaven. Both were good looking, well educated and had innate business acumen and management skills. After ten futile years of starting a family involving all medical interventions, the couple decided not to adopt a child or resort to surrogacy. Why bring another being in to this miserable world, they reasoned. Their minds in total synchronization, they thought of a care facility for the terminally ill. While Prashant will take care of for-profit end of the business, Mrs. Chopra will head the hope foundation. They took over the entire third floor of the MSH and remodeled into a state-of-the-art facility. Waking up with a start from her reverie, physically and mentally drained as she was, Mrs. Chopra made her way to the waiting limousine and reached her mansion for a well-earned night of rest.
Sanjivani in the meantime had her own recall of her past….
Brilliant surgeon as she was, the corporate hospitals wooed her as soon as she landed in India after a successful stint in the united states. She spent ten years in the corporate ecosystem where business took precedence over service and patient care. She saw at first hand the pathetic treatment of terminally ill, elderly patients unable to afford expensive hospices. Add to that, her cousin was having a torrid time managing her father who was practically a vegetable. She was not interested in raising a family. Romantic excursions, few and far in between did not interest her. She wanted to do something for the incurable cases.
One fine morning, she resigned her position with the corporate hospital. She ran a private clinic in her modest house to earn her bread and butter, but spent most of her time with an international advocacy group, “Right to Death”. It was not an NGO, subsisting on foreign donations, seminars and conclaves in 5-star hotels. It was pushing for legislative means to legalize Euthanasia. Everyone was a professional, volunteering their services. Sanjivani became briefly famous when a famous female anchor interviewed her on National TV. She was forthright in her views.
One Wednesday evening, she was relaxing in her portico with tea and a detective novel, when she saw an expensive limousine pull into her drive way. A uniformed chauffeur opened the door for an elegantly dressed dignified old lady. She got up and raised a questioning eyebrow.
The old lady started a monologue not allowing Sanjivani to get a word in edgewise. “Sorry, my dear, to barge in on you like this. But I just had to talk to you after someone sent me a video of your interview. Oh, where are my manners! I am putting up a “Long Term Care Unit” covering an entire floor of the Multi-Specialty Hospital. I need you to head it; no one else will do. Here is a pen drive describing the whole project in detail. Here is my card. You can check my background. Please call on me at my office on Friday morning at 11 am. We will finalize everything. By the way, I will not take no for an answer and your compensation package will be written by you and not by a CA or a HR person! I have to rush.”
She was gone in a flash leaving Sanjivani dumbfounded. She rushed in and brought her laptop and slipped the pen drive into the USB port. She read the plans and thought very seriously about the project. This is what she wanted all her life. Her quick research into Mrs. Chopra and the project cleared all her doubts about the genuineness of the endeavor. She started making a presentation incorporating her own inputs for the execution of this mission. She realized that saying no to this proposal did not enter her mind even for a second. She glanced at her watch; it was getting on to 3 am. She reluctantly went to her bed.
Entire Thursday was spent in refining her thoughts. She was at Mrs. Chopra’s office promptly at 11 am, the next day. She started her presentation. Neither of them uttered a single word about her acceptance or compensation package. After eight hours of non-stop discussions with occasional breaks for coffee and working lunch, Mrs. Chopra led Sanjivani to a well-furnished corner office in the LTCU. The sign on the door read, “Dr. Sanjivani, MBBS, MD, FRCS, DIRECTOR”. Mrs. Chopra said, “You work out your appointment and terms with our Mr. Ghosh, Director, Finance in a day or two, when you find time. He has strict instructions to accept whatever you want. He may advise on tax matters and align the package to your best advantage. But, your word is final. Please go home and take a breather. Meet me at my house tomorrow morning, whenever it is convenient to you. I have several important, personal things to discuss with you. Have a nice rest, my dear!”.
Next day, by 9 am, Sanjivani was welcomed by a uniformed butler into the living room of a sprawling bungalow which screamed wealth. Mrs. Chopra walked in and took her to the dining room. They were served a simple breakfast by a well-dressed young woman.
Mrs. Chopra then went on to explain that just as the physical modification of the third floor, financial closures and procurement of instruments were complete a few months ago, terrible tragedy struck. Prashant Chopra met with a terrible accident. He was brain dead and kept alive by life support systems. The irony of the situation struck Mrs. Chopra. She arranged for the donation of all Prashant’s Organs and pulled the plug. She said in hushed tones, “Then, my dear, my determination to fulfill our collective dream to care for the terminally ill was doubly reinforced. I decided that I need a head who will have the same passion to care for the ones without hope. And there you are!”
After some more discussions, they had a good working lunch. Mrs. Chopra then took Sanjivani on a tour to what she termed as ‘my humble garden’. Sanjivani was wonderstruck. It was in truth a mini forest. Fruiting trees, Flowering trees, vegetable patch, medicinal plants, spice garden. Looking at the awe in Sanjivani’s eyes, Mrs. Chopra chortled, “Don’t be astonished, my dear. I am a great manager. I found the right person for this job just like I got you for the foundation. Shyamsundar is a Ph.D, in Agronomy from Texas A&M, one of the top agricultural schools in the world. After a successful career with the FAO, he wanted to do something unique in our country. And I grabbed him. Besides being an expert in his field, he has sound overall knowledge, is dependable and possesses a brilliant analytical mind. You can call on him for any type of crisis management. He is on a field trip right now. You will get to know him by and by.”
* * *
Sanjivani woke up with a start. While wandering in her past exacerbated by a stressful day, she had dozed off in her chair. She unscrambled herself and went home for a well-deserved sleep of the just.
She was woken up at 4am by a call from Mrs. Chopra. Mr. Shukla suffered a massive heart attack in his sleep and passed away peacefully.
Next few months were hectic. Shyamsundar turned out to be an asset. He was her friend, philosopher and guide. He had great interest in Hindu spiritualism and a great follower of Swami Vivekananda. Sanjivani and Shyam shared a healthy, platonic friends with no romantic complications whatsoever.
During one of their board meetings, Mrs, Chopra felt breathless. Shyam and Sanjivani rushed her to the hospital. Within few hours, she passed away retaining her full senses until the very last moment.
After her cremation attended by VVIPs from all over the world, Mr. Ramaswamy, personal legal counsel for Mrs. Chopra, asked Sanjivani, Shyam and Mr. Ghosh, Director of Finance to be at his office at 9 am next day for the reading of Mrs. Chopra’s will.
The will was short and sweet. After various donations to charities and personal bequests to her staff, she has left her entire estate to Sanjivani. A high-powered committee including Shyam, Messrs. Ramaswamy and Ghosh under the chairmanship of Sanjivani will conduct the affairs of Hope foundation. No one except Sanjivani seemed to be surprised by the contents of the will. The collective smirks on their faces indicated that they were co-conspirators with Mrs. Chopra in the drafting of the will. Just as they were dispersing, Mr. Ramaswamy handed over a sealed envelope to Sanjivani. It was marked “To be handed over to Dr. Sanjivani after my Death”
Sanjivani was busy the whole day. She closed shop at 5pm and went home. She sat in her home office with tea and snacks provided by her housekeeper and gingerly opened the envelope. It read:
My dear Sanjivani:
I am really lucky to have found you. I hope that when you get to read this letter, I would have passed on peacefully. I request you to read the contents very carefully, give your deepest thoughts to them and decide the course of action you wish to take.
This happened a few days before Prashant and I decided to start a care unit for the terminally ill. I was totally immersed in the charity activities of Hope foundation. One of my most treasured duties was visiting terminally ill patients. I had seen firsthand the sufferings they go through. I had become very close to some of them. One such person was Madhuri, about 60 years old at that time. Both her children were well settled abroad. Her husband had left a huge fortune behind. She had multi-organ failure due to an infection by a superbug. She was on life support system due to her near vegetative state. Although her children had put her in a nice hospice sparing no expenses, her suffering was unbearable. She could still speak. She convinced me that I should pull the plug of the life supporting system. And, I did. I had no justification except my strong belief that there should be dignity in death.
When I returned home, Prashant sensed that something was terribly wrong. I burst out the truth. Not so surprisingly, he shared my views. We took Shyam, Ghosh and Ramaswamy into confidence. All of us were of the same opinion that hopeless souls should be given a dignified farewell. But we put in strict guidelines.
- The intended candidate should have specifically sought relief
- There should be zero chance of recovery as supported by expert medical opinion.
- Not only we will stop life supporting systems artificially keeping them alive, we will even actively intervene when necessary.
- The final decision will by 100% unanimity amongst all of us. If any member has even a slight doubt, we will not proceed further.
So far, we have given relief to 6 persons. Latest was Mr. Shukla. Shyam can provide plant-based ingredients which can effect relief without leaving any traces. All the deaths so far have not evoke any suspicion because they were all expected to die anyway.
My dear, I know this comes as a shock to you. We know that you have seen the suffering first hand and have openly advocated Euthanasia or mercy killing. You may join the group in my place and select suitable candidates for relief as per above guidelines. We will understand fully if you cannot be a part of it. If so, the entire program of euthanasia will be scrapped. You will still be in total charge of Hope foundation and the LTCU.
I request that you give serious consideration to our proposal. I know all of you will collectively make a decision only in the rarest of rare cases.
However, if you agree, call an emergency meeting amongst the four of you and proceed. We are not playing God. We only protect the right to die.
Blessings to you, whichever way you decide.
Sanjivani realized with a start that this is the first time she came across the first name of Mrs. Chopra. She was always Mrs. Chopra to everyone and will continue to be so, at least for her. She knew she was escaping from considering this momentous news by allowing her mind to drift over trivial matters.
She powered up her laptop and did a serious research on “Euthanasia, passive and active”, “Assisted suicide”, “Living Will “and all related matters. When she grew weary and tired, she realized it was nearly four in the morning. All this time, tears were flowing intermittently from her eyes.
She took a deep breath, sent off an e-mail calling for an emergency meeting of the empowered committee to be held in the offices of the Chairman of the Hope Foundation.
Wearliy, she rose from her chair.
So did Hope for the Hopeless….!
- This was inspired by the Aruna Shanbaug case. A junior nurse in a Bangalore Hospital , she was raped by a ward boy, strangled with a dog chain and left for dead. She was saved, but was in vegetative state for 41 years. https://en.wikipedia.org/wiki/Aruna_Shanbaug_case
Ironically, the rapist was released after serving a sentence of 10 years ( after time off for good behavior), got married and living a normal life.
- Euthanasia (mercy killing) derived from Greek words, Eu- meaning good, Thenatos- meaning Death . It is of four kind, passive, active, indirect, and Physician Assisted Suicide. https://en.wikipedia.org/wiki/Euthanasia
- Euthanasia, in one form or other, is legal in several countries like Belgium, Luxemburg, Canada, the Netherlands, Switzerland, Germany and several states of USA.
- On 9th March 2018, Supreme Court of India legalized passive Euthanasia restricted to patients in vegetative state or brain-death
- One can write a living will authorizing stopping of life support system in the eventuality of vegetative state or brain death
- Code Blue is one of the emergency procedure codes for cardiopulmonary arrests and life-uuthreatening emergencies in areas of the hospital.
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