What matters in the end

My grandmother passed away 3 months back. 3 months and 13 days ago to be precise. A lot happened before and after she passed away. Her life and passing away made me realize some important facts about life and more about death.

My grandmother was no less than a third parent to me. I have lived all my life in her presence. She has seen me grow up from a baby to a woman, while I had seen her become a baby from a fine remarkable woman that she was. Life is definitely a vicious circle and growing up with Patti taught me that. With her passing away, the one question that hovers in my head is ‘what is it that really matters in the end’?

July 8^th 2016 was the day my Patti breathed her last. Scenes from the day are hard to forget. They appear like a movie scene right in front of my eyes.  Patti had a fall in the mid of June.  She came to eat her dinner one evening like she always would and all of a sudden she lost balance and fell down. My parents and I were right there and didn’t know what caused the sudden loss of balance. We moved her to the bedroom and comforted her.

For the past year and a half, Patti suffered from moderate dementia. She had difficulty doing her daily chores like using the bathroom or draping her saree, remembering names, and recognizing extended family members including her own sisters. She had difficulty comprehending instructions and expressing emotions be it pain or happiness. If she was happy she would smile and take my hand and give me a kiss.  If she was irritated or angry she would tell me to shut up and leave her room. She behaved just like a child and small things made her very happy. She would nudge my stomach when I sat near her and laugh when I twitched. A piece of cake or chocolate made her very happy. Wearing pink nightgown that I had bought for her made her smile and she would become very sad when it had to be changed. Over the past few years, it was a family custom to have dinner together. All of us would gather in Patti's room to spend the whole evening with her. Patti's room was converted to our living room and dining room. If we ate something different for dinner than what she had eaten, she would ask my mother why she wasn't given the same dinner as others. If any day the custom changed because of an unexpected event like going out for a wedding, Patti became very upset and would question us as to why we left her alone.

Patti had started having falls and blacked out a couple of times in the past two years. It was due to mild TIA or Transient Ischemic attacks the doctors said. Older people were more prone to it. The day she fell down in June 2016, was the last day she walked on her own. She was confined to bed after that for 20 odd days. Multiple doctor visits, a short stay at the hospital and back, nothing made a difference or improved her condition. All her parameters were normal and the doctors had only one answer ‘old age’. Eighty nine and a half wasn’t young, but my Patti was always healthy and she had always fought many such incidents in the past. That made us hopeful. She had even reversed her diabetes with a strict diet. She had no blood pressure or cholesterol issues. Despite her fall she didn’t fracture a single bone.

But this time the situation was different. She would lament she was in pain and often cry that she wanted to go. She had made a resolve to leave the world. Every time she spoke she spoke of leaving and said she didn’t wish to live. No amount of coaxing and cheering her up made her change her mind. She would murmur every night ‘ Bhagawame yenna kootindu poidu’ – ‘ Oh lord, please take me with you.’ One day when she was lamenting ‘I’m leaving’ , I asked her where she wanted to go.

“Very Far”, she said.

“Even I want to go Patti. Let me come with you” , I said.

“You’re too young just shut up. You cannot come there. Go do your work” came the reply.

I was astonished and shocked. She refused to take medicines, food, and even water. She didn’t reply when we would ask her if she wanted to eat or drink or if she was in pain. How did she answer me so cleverly?

The sub-conscious mind is a powerful weapon. I learnt that from Patti. She would never speak but would clench my fist so hard that it hurt. She decided to leave the world and she firm in her resolve. She stopped eating or drinking even water during her last few days. We did coax her but it was in vain. She would clench her lips together and just wouldn't open her mouth. She loved any form of sweet, and even the trick of offering her sweets didn't work.  

On the morning of July 8^th, I asked Patti if she would have Proteinex, a drink she normally loved, and she nodded her head. I fed her 2 spoons of Proteinex mixed with milk, with great difficulty as she refused to open her mouth. My brother had come home to see if things were fine and if we needed any help.  I noticed her breathing was not fine and she was having breathing difficulties. We checked her oxygen concentration and it was around 70. Normally the oxygen concentration should be around 95-100 and anything below 70 was a cause for concern. I immediately called up the doctor and rushed to my uncle's house to get an oxygen concentrator. We came home and fit the oxygen concentrator but her oxygen gone down further and the reading in the pulse oxy meter showed 58.

The doctor arrived and said she had suffered a pulmonary edema, which meant there was excess fluid collection in the lungs and her chances or survival was only 20%. Even if she did survive she would need ventilatory support. We wanted to rush her to the emergency and I was frantically calling for the ambulance. Meanwhile, my mother sensed that Patti might be nearing her end had phoned up her sisters who lived close by. Patti's sisters did not want to put her through the torment of hospital, injections and ventilatory support and wanted her end to be peaceful. She was surrounded by her sisters, her maid who had served her for the last 45 years, her son, daughter in law and her grandchildren. I held her hand for the last time. She had no grip. She threw up the last bit of milk I had given her. Her eyes kept rolling looking at everyone surrounding her as she was struggling to breathe and suddenly she stopped.

While most of us talk about the quality of lives we want to live, hardly anyone talks about the quality of death.  Atul Gawande, wonderfully expresses this phenomenon in his book ‘Being Mortal’. I wonder if death could be gratifying. While it does bring sadness and takes away our loved ones from us forever, it makes us realize that it’s nature's terrible game played with mankind. That’s how I saw it. While death to many is an end of suffering, it is an abrupt end to dreams and future for many. Some are lucky to escape suffering. Some are lucky as they get to say their good byes. But death always leaves questions that are unanswered.

When I think of old age and the kind of old person I want to be, I always think of downsizing. I should be able to downsize all my needs into a single suitcase, light enough that I could carry by myself. That way I wouldn’t accumulate too much junk or wouldn't regret not having used half the things I accumulated during the course of my life.

My Patti didn’t carry anything with her when she left. She hardly wore any jewels except for a red plastic bangle that she had always worn. The red plastic bangle was a gift from her husband who died when she was barely 32, and she would never remove it from her hand at any cost. Eventually, she forgot the sentimental value the bangle had. She carried no memories. 

Patti carried with her a sense of fulfillment, she had lived a long life and decided it was enough. She carried with her love from people around her. She had everyone around her telling her she would be fine and everything is going to be ok when she was dying. These soothing words, however far from the truth, is something we always yearn to hear. Hearing these words from loved ones as we fight our last battle on earth, could define the quality of death.