Saturday, October 25, 2014

To Die with Dignity

The Rest

The fact is that we all die. Sooner or later, for one reason or another, we die. Also, there are two kinds of death, mainly - the sudden and the long-drawn out, dragging on kind.The other fact is no doctor, whatever his credentials are, can grant us immortality. Now most everyone hopes for a sudden, painless death, but not many meet their ends that way.
Those facts are inevitable, and out of our hands, but there is one fact that we can control – to a certain extent. Here is where scientific advances should help us deal with it in a better manner, when the time comes. Doctors could help improve the quality of our lives, hopefully.The pain, if there is any, for instance, while nearing the end, and the way it all ends, can be controlled to a great extent. And then there is the other emotionally charged issue of taking care of the older generation, once they are totally bedridden, in the right manner.  For me, how these matters are dealt with, is a sign of the amount of  progress in healthcare in a given society. While most western societies have made great strides in some of these areas, societies like India are still enmeshed in the old taboos and fears and guilt, and shame. We Indians pride ourselves in that we take care of our old. Maybe it is true in some ways. However let us take a close look at the reality here.
 The grandparents are still important parts of the family. Many sons and daughters take care of their parents in their old age. But old age does not preclude just a sage wise person sitting in his or her arm chair handing out wisdom and memories, and smiling at the antics of the grandchildren, telling stories of old times.  Things could change in the blink of an eye, for as time goes by, that machine that is our body will go haywire. And the older person is struck down all on a sudden. What now? Many children and/or the spouse of the invalid still try to do their duty to the best of their abilities. After the initial burst of overwhelming help and support by everyone around, if he or she bounces back, things go back to normal. But if the condition deteriorates and the elderly individual succumbs to “real” old age, there will not be that many around – just the immediate family.  Most often, especially in my part of the old country, it is the sons’ wives who get that responsibility. Daughters, if there are any, visit once in a while, and depending on the situation, and their personal nature, find fault with the way things are done, or not. And they are supposed to take care of their own in laws. Needless to say the now grumbling daughter in law carries on the thankless job. Anyway nobody is happy. By the time the older person is totally immobile, completely bedridden, with or without his mental faculties, his condition has drastically changed from what was before. Soon he or she is relegated to a room away from the main activities. The toll of taking care of a completely immobile person with no end in sight hits everyone –  economically, time-wise, emotionally. In many households hygiene of the older person becomes practically impossible to keep up. Infected bed sores, the stench of bodily excretions, and above all, the agony, frustration, loneliness, and helplessness of the once able human being, and that of the care giver. I have seen many an old person who is emaciated, curled up in a fetal position, with eyes staring vacantly, sometimes howling in pain, and visitors looking at him or her with pity and wonder. That person has become an exhibit to look at, and to the pious, an example for what human vanity and pride comes down to in the end. The person is bereft of whatever dignity he had, reduced to a shadow of what he had been. No one thinks of the care giver, who most of the time, would be a woman, by the way. Sending them off to hospices, or homes, however comfortable and well equipped these are, is still considered cruel and selfish. It is as if we are throwing away our older people once we have no use of them. But we need to rethink these ideas. At least with our generation, when we have come so far, we need a better plan.
Let us take, again, some characters from my part of the world. Now I can understand that the doctors and the hospitals need to make money. But when we know that many of the doctors there became doctors because their parents paid the colleges hundreds of thousands, even when  the son or the daughter has no aptitude, and when some are really dumb, money becomes really significant. The parent has the money, so the children shall be doctors. And have to try to get back that investment and more, by going into arranged marriages. Again. money from the girls’ parents. But most of the time, this money from the girls’ family ends up going back to the girls’ family within a year. The daughter sees to that if she is smart. So what now? Squeeze the patients. What else? Ply them with tests, treatments, drugs – sometimes useful, at other times, not. Since there is no accountability in these areas, doctors and hospitals get away with mistakes of many kinds. But that is for the living. What about the dying?
Suppose I have been diagnosed with a terminal illness like cancer. The doctors themselves say it is incurable, as it is stage 4, spread to all areas. But then comes the double talk. In one breath they talk to you about “palliative” care and “aggressive” treatment, say, chemotherapy and radiation! Totally misleading, and contradictory. The patient’s loved ones are at that point grasping at straws. Hoping against hope, and unable to think clearly, they go along with whatever the doctor says. Like car salesmen trying to sell varieties of useful and useless warranties to the unsuspecting, vulnerable customer, doctors shove down futile treatments onto terminally ill patients. This is not limited to India – happens in the West too. Money may not be the only reason behind it. Adherence to traditional, supposedly more ethical thinking and a whole lot of complex layers of reasons could be acting here. But money is one big factor, like death. The only useful and possible warranties that the patient could get are to be free of pain, and to die relatively comfortably.
The only advantage here is for the doctors and the hospital in which they have shares. Here enter the tubes down all your orifices, the other main character, the ventilator. Recently I heard of an elderly woman whose husband was diagnosed of some illness and was under treatment at a reputable hospital in India. She had no idea what the illness was. One of those medical mysteries. Anyway the man slipped into a coma. The doctors had given up hope. They said there was no cure. Still, tubes were down his throat, soon he was on a ventilator. After two months of this, the man died. Meanwhile the woman had sold everything of value including her house to treat her husband. Now she goes to work in of our neighbor’s homes as a cleaning maid and lives in a room paying rent. So many questions arise, so much pain could have been avoided.
 Another case – A 75 year old nun fell. She couldn’t walk after that. Nothing wrong, the experts said. Soon she is bedridden. After a couple of weeks, she refused to eat. Clearly she was fed up of everything – the prayers, the mockery, the indignity, the great fall from who she was once, and most of all, the pain.  Reduced to skin and bones, and clearly depressed, she stopped talking or responding. Still they plied her with stuff for that complex, unknown reason. She was still in pain. Totally silent, except when she was screaming in pain, soon she lost what was left of her mind. She lay there curled up. Her refusal to get up and walk was seen as stubbornness, and an act of defiance against god. Her refusal to pray is seen as a sign of her inherently evil nature. In fact they shove prayers down her throat persistently, when obviously, all she wants is peace and quiet, and something to make the pain go away, and possibly, just to die. Pious songs broadcast all the time, Holy Mass droning on, on the TV set –what more could she want, her visitors marveled! Any sane person would go crazy in that atmosphere. Her pain is looked on as punishment for her sins, for her pride when she was young.  Her suffering is at once an exaltation, and an example of, the end of, the futility of  all vanities. And all this in a place where all the inhabitants are educated, where in fact they run a well equipped hospital with highly trained specialists. But since they believe in the sanctity of human life, she is still kept alive. Tube down the throat.  Must make them feel virtuous. It is also to show the nun’s relatives that they are doing everything to keep her alive , that they are not killing her off. Litigation is what they are afraid of.   This happens in many a layman’s home too. This is one way that religion  aids and abets that hope mongering business of the doctors. After all, we Christians exalt suffering, as if God is a sadist whose main entertainment is watching humans beg and crawl, and howl in pain.
 I know many including the above-mentioned doctors  wave the “positive thinking”, hope and will power flags. That is just it- waving. Not very different from the snake oil -charlatans who pretend to work miracles, exploiting the weakness of the common man. Once the body is ravaged by a terminal disease and when there are no cures in the offing, no amount of positive thinking is going to stave off death or pain. Feeding on the patient’s and his loved one’s misfortune and vulnerability  is not ethical. I know these “godly” doctors will tell you oh so humbly that they are not gods, that it’s all in god’s hands, (what's he doing here then?).And there will be his colleagues who promote the hype of a particular “godly” healer - so he could be god! or so we are made to think. So the godly person lets us go on suffering.  As if he can grant us immortality. They all share in the profits. All the while they do know when a person’s body is run down, when all his vital organs are shutting down, and that he is in intolerable pain, and that he is not  ever going to get up and walk around, fit and strong. If there is a little bit of humanity left in these healthcare professionals, they will treat that pain, and tell the truth as they know it. It’s up to the patient, the individual to decide when to go based on that knowledge. That is the scientific advance that I want. That is why we read of doctors who decide to put an end to their own lives when they know they cannot stand their own suffering, when they do not want to be a burden on their loved ones.
Money is in the prolonging of a life that struggles to escape. And now a days there is the waiting for the arrival of any children who live abroad. The patient is kept “alive” till these relatives can see him. It is as if no one cares about the suffering of the individual. For the past few months, I have been watching episodes from Herriot’s animal stories. That was the first time I had known about the TV series, even though I had known of the book.  I was touched by the kindness and love that those owners and vets shower on their patients. And when they know that an animal cannot live a useful life any longer, that it has to suffer pain unnecessarily that nothing can save it, they have it put to sleep, gently, as much as they can. Now I am not touting euthanasia here for all the sick people. Being human, I am talking about the individual’s right to choose his or her own end, and to be free of pain, when the time comes. By a sad coincidence I just read about the actress who played Herriot’s wife, Lynda Bellingham who stopped her aggressive treatments for the cancer that had spread to her liver. Just before her death she talked about the effects of chemotherapy that people are not aware of.
When we know that the end is here, we should be allowed to go a little gracefully, with a little bit of dignity. It is time to ask certain questions to ourselves, to the society as a whole.  And to answer and act accordingly without fearing what others would think :  Why aren’t we thinking of that time of our end here a little more?  We seem to be inordinately interested in life after death. Religions especially. But isn’t it time we thought about death? Its practical side?  Why do we exalt needless suffering? Why do we feel the need to prolong life that is insufferable? Can’t we show a little bit of kindness to ourselves? As it is now in India, one thing I am sure of is that I would not want to die there. Her fatalistic, cavalier attitude to pain is frightening. I will have to go live in a country where they provide assisted suicide to those who want it.
This is where “living wills” come in. The public has to be educated about the importance of having a plan for medical care when the end of life is near. A plan for dealing with death. while we are able to think for ourselves, we make that living will. Death could come at any time, to the young and to the old. Accidents happen. Illness, surgeries happen. We should be able to decide what should be done if things go wrong, when we still have our mental acuity. So prepare that living will today. Let us try to die in peace. To the religious, God would not want us to suffer. He or she would want you to take advantage of the scientific progress that human beings have achieved under said God’s guidance.
According to the Mayo clinic site,  Living wills and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives guide choices for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.
By planning ahead, you can get the medical care you want, avoid unnecessary suffering and relieve caregivers of decision-making burdens during moments of crisis or grief. You also help reduce confusion or disagreement about the choices you would want people to make on your behalf.
Advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to prepare these documents.”
Besides that, our healthcare providers  should admit that we are nearing the end, when that is the case. The whole process, all the information has to be made available to the patient. Such transparency will make it easier for the individual to make an informed decision. Of course we should be free to seek second or third opinions, if we want to. But they have to give us the truth as it is, and we have to accept it. We all say that death is inevitable, but it is hard to look it in the eye when we are made aware of it. 
Related to the end is the treatment of pain. Everyone including the doctors must know the meaning of “palliative” care. At that time when we need relief from pain, we deserve total relief.  And that may lead to a quicker death. Let it be. The transition from life to death should be gentle, soothing like one is going to sleep. That would mean a lot more hospices, and care homes for the terminally ill, for the older members of our society. Humane, ethical institutions which are accountable to the society. And that would mean all the more responsibilities on the part of the society to make sure that they are run with the one intention of the well being of the patients. For making sure that they will be comfortable till the end. And we must realize that it is all right if we decide that we are not able to look after our loved ones satisfactorily. In fact we should be true to ourselves, ask ourselves if we are helping our loved one in the best possible manner. If we think that we are not, then we should seek help, without guilt or stigma. The State’s responsibility should not end with the death of a person, but it should include the process of dying. Each one of us should take responsibility for our ends when we can, and ease a little of the burden off our children., and try to help educate our still unaware countrymen.
 Please read the whole article about “living will” here:

Thursday, October 23, 2014

The Course of Married Life

Marriage of the Virgin

Those who have heard me say this before please bear with me. That is, if marriage, whether it is- arranged/not-love, or love marriage, as we call it in India, is an institution, then there should be a limit to the number of years we spend in it. For someone steeped in western and modern thinking and culture, this would seem obvious. But for someone like me who grew up,  let's just say, in a "quaint" culture, it would be a godsend. Again, to describe that someone like me, for instance, for those brought up with that inordinate yearning to be liked and approved by everyone. So a society- approved cessation of our stint in that institution would be to my liking. Once you complete certain lessons, and take a few tests, you pass. Just pass or pass in flying colors. Once you put in the number of years in the contract, you are free to go. Degree in Married Life. At some point, after the initial beginners's classes, of course you are on the job. Trainee at first, but soon, full fledged worker. Some become the boss and teacher, while others remain the student and the employee. Whatever your designation, what if at the end of the stipulated time, you receive your Award and/or Degree or your duly stamped Passport to freedom?

In any case, I think that at certain points while you are in that great Course, Degrees could be awarded. In recognition of the learning and the experience.  This is assuming you are with the same person throughout the course. If it is with somebody else, you still get awards, different ones – for your extraordinary attitude of hope, and unfailing faith in, and admiration of , the  value of the education that you receive from that great institution.

At the end of the first year - A Certificate - Married Life 101

At the end of 5 years - Diploma in Married Life 110

10 years - Degree awarded - Bachelor's in Married Life

20 years - Master's

25 years - Ph.D in Married Life

Over 25 years - Nobel Peace Prize

Over 50 years - no Degree, no award, Virtue being its own reward. Except maybe dementia, depression, death, at least for one, in the pair.

Thursday, October 9, 2014

Poetry Points - How (not) to write Poems

the poet 

I have noticed that I am always ready to preach, but not to practise. Especially when it comes to writing. It could be that I am pretending to myself that  that is the reason I am not a great writer, or a famous writer. I prefer to overlook the highly possible fact that I just do not have what it takes to be one.
Anyway here goes, - now that I know for sure that I am never going to amount to much, and that I never did, I can dole out advice freely. Time to grow up.

To  budding poets/writers, especially those whose mother tongue is not English :

We all know good poetry is sincere. That it is authentic, and arises out of the heart and mind of the poet, his/her experience/knowledge - from a variety of sources.

Poetry is the spontaneous overflow of powerful emotions, Wordsworth did write that. Coleridge took it a bit further. And we in India read the 19th century English Romantic poets more than anybody else, at least that was how it was in my time. Of course we did read others. But somehow for us back then the Romantics embodied greatness. They were the role models. That perspective could backfire sometimes. Great, original poetry was written by them, or so we think, rightly or not.. Colonialism did affect our thinking.  Still, what they wrote then still manage to amaze us. Times have changed. For us now, we can be inspired by them, however, unless we have some new way of talking of those same themes, we have to find different subjects.That of our time. There are some ideals  that will always be the same, such as love. But even that has changed. New versions or rather supposedly new versions have appeared  However old or new these versions are, we will have to find new ways to describe it. To write poems about it. So let the emotions and ideas fester in the mind. Take the time to make it your own. Turn it over and around, think how to enrich it using the knowledge you have gained. Which process you already do, I know. Do more of that. Read more, live more. Books from all lands, from our own land, from the present, the past, movies, music, science, philosophy, the internet, and art, and travel are some ways to gain more knowledge, expand our perceptions.

Talking of the Romantics, be very careful when writing nature poems generally. That's because many of  those descriptions and imagery  have been overused down the line, and nowadays they are everywhere, from old romantic poems, from  new and old love songs to Hallmark cards.  Thus, sadly, the golden orbs of the sky, the transient dewdrops, "beaded bubbles winking at the brim", darkling anything and unquenched desires have all become trite. Let's say that those Romantics have among themselves pretty much exhausted all the yearning sighs of lovers, the arching azureness of the heavens, and the writhing demons of desire for the forbidden. You can still write about Nature, and desire, and love, and death - in refreshing new ways. Using unexpected but unpretentious words and images that make sense and that make the reader stop and think. They could be ones of fantasy, of the modern times, of the past, of the great treasure chest of mythology, gritty and/ or charming, and/or rural or urban, suburban, and much much more.

Apart from the usual culprit named grammar, there is one common element that most new writers of poetry misuse. Ellipsis - those 3 dots -  is not a  device to be used indiscriminately. It is not there to prove that a piece of writing is indeed a poem. We all know we are reading a poem when we read one. No need of ellipsis just for that. Use it sparingly, for the most effect. Same with the overuse of "like" for introducing similes.  When you delete just those two factors itself, things change. Getting your meaning across would be a little less easy. That might entail a lot of reworking of the whole piece. But it will make one think beyond the usual clich├ęs, and make the poem fresh. Most poems could benefit from an overhaul. Make it shorter, denser with apt but unpretentious devices, make it more succinct . Better to have drama rather than melodrama, I think. 

Be careful when you are determined to  write rhymed verse, sometimes they look too forced. Especially when you pick up weird but rhyming words from the thesaurus. Poetry should flow naturally. So is with the use of uncommon words. That just looks pretentious, and many readers will not bother to find out the real meaning. Loss of communication. Some use "nay" and prithee and thee for their poems which, let us say, is amusing. And a lot of question marks, and words in all capital letters to make a point, or to show someone is shouting. ( I have done that!)  I am enjoying writing this! It sure feels good to pontificate!

Also, I do not think readers enjoy too much preaching/pontificating in poems. High morals and ideals, and observations of that nature are good, actually it shows an observant mind. But a poet has to go beyond just stating the facts. Show the pitfalls of evil or sin in simple but symbolic ways. For poems in general, I prefer “showing” rather than “telling”. Or a good balance of show and tell. Again, read more, observe more, think more, live more, I guess. Poetry is an attempt to transcend the concrete, using various poetic devices and at the same time, capture it. It should make the reader feel and think beyond what is written in the poem. I am not asking  that a poet should be obscure, but the poem should spark, trigger ideas in the reader's mind. Provoke. Inspire.  Just my opinion. 

Early poems, say of a very young person, are useful in the sense that the reader can see how an imaginative, intelligent young person  with a good grasp of the English language saw the world around him or her at a certain point in time. But many creative young persons have done the same, which is fine too. But when they all do it in rather similar ways,  it stops being that special. But it still could be special for some readers. Here's where knowing your audience works. Who are you writing for? For yourself? Then it's all fine. For young people of your age? They may like them. For a few youth of your age? Sure, some will like them. Now, how about older readers? And we are talking of the ones who like to read poetry. How about an international reader?  I am not sure how they will read them. What I am sure of is that if the poems are good, they will see that there is potential, and there is time before you, to get the experience, through just living, through books, movies, music, works of art, through travelling. A talented, aspiring poet should realize that not all are literary minded. Not even students of literature. They are not able to write or think like you. You are different. You can write. You are  budding writers. And it takes time and work to be  great writers.

  I do not consider myself to be a poet, let alone a good one. I am guilty of many of the issues I have mentioned. And I am too lazy to change, and that may be one, just one, of the reasons that I am still unpublished by an established publishing house. Remember what I said in the beginning? Fooling myself. But  I can recognize good poetry when I see it, most of the time! I may be totally wrong too in my opinions. Appreciation of poetry is totally personal. Ask others to read the poems, (criticism hurts, but it helps too, they say) maybe an English teacher of yours, or a published writer - not a self-published one, preferably.  In this age of self-publishing, and success through effective marketing, or by "going viral" (yikes!), or by just having a group of enthusiastic, supportive friends and  as all of you happen to live in a big city, where they can even start a publishing house for you, and/or if you are web-savvy, anyone can be a writer. Well, these days they have courses in creative writing. But to be  writers whose writings stand the test of time, to rise above mediocrity - that is the ideal. And I believe a moderately talented, determined person can do it, with a little bit of luck . 

However, it is your choice that matters the most, when it comes to publishing right away. Choose your favorite ones, work on them if you feel like they need work, after hearing competent readers' take on them. Those should not be confined to your usual set of admirers, made up of people who dislike any kind of creative writing, or who just read comic books and romances,  your love struck boyfriend or girlfriend, or an apparent hotshot connoisseur whom you met online who is really just angling for a bit of romance on the side, via the net or via Main Street/M.G. Road, your younger siblings , (guilty here )or just one of your indulgent teachers who thinks the world of you because you have a good vocabulary, and you are one of the few who could write a complete sentence without making any spelling or grammar mistakes, and because, maybe unconsciously, you walk around thinking you are Keats or Emily Dickinson, and managed to fool them too!

Don't be afraid that a good critic or fellow poet will steal your thoughts, or that they will be envious and put you down on purpose.  Not that that does not happen, it does. But most often, your current attempts are not that original or perfect for them to copy. I may be wrong about that too now. Some would-be poets and novelists avoid reading others' poems and works of fiction fearing that they would be influenced. As if their very unique genius, and sublime innocence and purity of thought will be tainted by the others' views. The noble savage has to remain so! The other fear is different - what if the other person is better than you? And you think that might make you feel anxious and jealous and leave you unable to focus. Another fear is that of failure. What if no one likes your work? And at the other end are those who fear success even before they taste it! So they sabotage themselves in many ways. Fear and laziness - two evils that pull us down. Look who's talking! 

In spite of all that, if you think your poems are good as they are, I respect that too. After all, you are the author. And you only live once, and this is the age of self-conscious living! (I did it! - I went and self-published my 2 books. For my first novel, I did the "query" thing -- did not work. So went the digital publishing way. The second one, the poem thing, I just didn't bother doing the query procedure - I knew my poems were nothing to write home about. Anyway I avoided the pain of rejection and by that also the joy of recognition. Lesson learned - no pain, no gain. The only difference between you and me - I am older, and do not have time and youth on my side now). Besides, you won't be around to see if your work stood the test of time!

The suggestion is to wait. And then write, and rewrite incorporating new insights.I know many writers or aspiring writers cannot bear to rewrite and revise. I am one of those. But I also know that revising and reworking our writings will make them all the more substantial, rich and polished.  If there is talent, that  needs to be nourished, sustained, and grown. I have heard drugs and alcohol fuels the imagination and many a great writer and artist have used that throughout history. In fact there seems to be a huge market for redeemed addicts' - that is with addiction of any kind, love, religion,sex, drug, alcohol, food,politics--  writings. Well, that can mean that they are passionate about something, or that they are intrepid warriors of experimentations, those who are not controlled by boundaries. But let me make it clear to you young writers - I do not recommend that. Why? For one, most of the time those artistes/artists are too much into their experimental living that they are unable to enjoy their talent(s). For two, they just get stuck in the experiment and not in their art. The greatest among them do not see their own fame or popularity in their own lifetimes. Be sensible, or not. But take care of your body and mind. Make reading  your addiction, if you will.

Now, there are those who are physically enabled to be highly creative artists, they say. Synesthetes like Vladimir Nabokov, tetrachromats like Concheta Antico may have used their special gifts in their creative endeavor. Some say people can be trained to see and feel the world like them. Till then, for the rest of us, good old reading and living and talking and thinking will have to do.

Saturday, October 4, 2014

there's work and then there is wo....rk ...

Caution! Men at work!


Just thinking of this scene makes me laugh out loud. Well, I guess it is the intention that counts. They should be paid for that.

Asterix aficionados will know this from "Asterix and Cleopatra". Where the heroes are in Egypt taking in the sights, and are introduced to the people and their customs. What makes me laugh even more is when I think of some of my volunteer jobs. Let's just say that I wasn't needed that much at those places, that I did not make that much of a difference. Or, the brick did not budge an inch, or less. Of course not all volunteers or volunteer posts are like that. No offence intended. Once I was reminded of this scene when I saw a lone construction worker in the driver's  seat of some equipment on a Sunday, in one of the construction zones on the expressway. He may have been doing something useful surely, but I couldn't help wondering what the heck he was doing there? :)

This is what the work really looks like, by the way.
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