Care, at close quarters

In a day, Madhuri visits four, sometimes eight, homes. Today, she will visit three women who are in the last stages of cancer. The rickshaw takes her to the upper middle-class home of Meena Virani. The door is ajar, and Madhuri walks straight into the bedroom, whose door is shut. Virani8217;s mother-in-law informs, 8220;She threw up on the bed and is being changed8221;.

Two years ago, 42-year-old Meena discovered a lump in her breast; the malignancy has now reached her brain. She had a few cycles of chemotherapy but to no avail.

After having been admitted to the hospital several times, Meena chose to stay at home. Now her daughter Sonal, who has taken a break from college, looks after her. When Madhuri enters the room, Meena8217;s face lights up. 8220;I am feeling much better now, doctor.8221;

Madhuri is here not only to dispense morphine, that will take care of her pain, but also to offer counselling and advice to the family members. Says Madhuri, 8220;When such patients start feeling better, many a time, the family members start thinking that the patient will survive. But that does not happen. So though Meena is feeling better, I have to keep encouraging her on the one hand and on the other, remind the family members that this is just momentary.8221;

Though Meena has been drugged and is feeling sleepy, she complains, 8220;There was a time when all my relatives would come to me for advice and I8217;d help them out. But now I am tired of listening to their hassles. My head hurts and I feel extremely queasy but still they come and unload their emotional baggage here.8221;

Holding her hand, Madhuri tells her, 8220;I know how you must feel, but remember that you have to conserve your energy if you are to get better, so ask your family to restrict people from visiting you unnecessarily.8221;

Madhuri explains to us, 8220;Her relatives and friends have not been told of her terminal stage. That would mean an unending stream of guests, which will tire her more. Besides, some insensitive ones could pass hurtful remarks.8221;

Though Sonal is now an efficient nurse to her mother she gives her a bedpan, sponge-bath, and even the saline drip if required, time was when she was a mental wreck. Says Madhuri, 8220;Sonal could not accept the fact that her mother was going to die. All she could do was cry.8221; But with some counselling from Madhuri, today, Sonal is in a position to care for her mother.

Meena, however, is unaware that her daughter is missing college only so she that can care for her. The lesions in her brain have engulfed her in a world that slips in and out of consciousness, so it is easy for her to believe the little white lies she is told.

After about an hour, Madhuri leaves the Virani residence. We are to meet 65-year-old Denbai Dhabade, who lives in a slum in Kondhwa. Says Madhuri, 8220;Doctors cannot do much for terminally-ill cancer patients. They concern themselves only up to the treatment stage. When all else fails, such patients are asked to go home. But while the patients may not respond to any treatment, it does not mean the suffering has ended. In fact, this is when the patient needs help to manage the pain.8221;

Denbai is lying on the jute bag that doubles as a sheet. When she sees Madhuri, she sits up. 8220;So, how are you today?8221; Denbai is miserable. 8220;I can8217;t bear the pain. I don8217;t feel like eating because of this burning sensation in my stomach.8221; Madhuri listens to this and then gives her packets of oral rehydration solution she can drink.

Denbai is being looked after by her daughter, who sells vegetables to make ends meet. Says Denbai, 8220;My son cheated me. made me sign all the papers transferring my land in his name. Now, when I need him, he does not even visit me here.8221; She begins to cry. For she is not only a victim of cancer, but also of poverty, not even the temporary relief money can buy is available to her.

All Madhuri can do is console her and give her medicines. 8220;Don8217;t dwell on the past. What has happened cannot be changed. You have to concentrate on getting well.8221; She examines her and dispenses medicines that will take care of any pain she will feel for the next week.

Three months ago, Denbai was suffering from post-menopausal bleeding and non-diagnosis. Says she, 8220;I went to the local doctor and he gave me some medicines for a few days. Then one ayurvedic doctor promised to cure me. He took Rs. 3,000, for which I had to take a loan. But I was still suffering.8221;

It was only when she went to the Sassoon General Hospital, which referred her to Satseva, that she now has relief from the cancer growing in her uterus.

The rickshaw takes us to the third home on East Street. Veena Shah, a 70-year-old widow, whose breast cancer has spread to the bone, lives with her daughter here. Her family called on Satseva because it felt she needed counselling.

8220;Though all my patients know their case is terminal, they want to live. And till they have this desire, they do. It is only when the pain becomes unbearable that they give up hope. And when they give up, they die within a short time.8221;

Shah is bedridden because her hip bone hurts. She is undergoing chemotherapy but is refusing to eat. Says daughter Vidya Patel, 8220;She simply refuses to eat. Whatever she eats, she throws up. We called her oncologist several times, but he can8217;t do anything till he sees her. And to take her to the doctor even for something simple like indigestion would involve calling an ambulance and taking her on a stretcher.8221;

Madhuri listens patiently. Vidya has several complaints. 8220;She asks the maid to first keep the bucket ready in case she throws up and then eats. She does not even make an effort to eat otherwise.8221;

Her mother is silent all through. Madhuri then asks her how she feels. Speaking feebly, in marked contrast to her daughter8217;s worked-up utterances, she says, 8220;I can8217;t eat. Whatever I take, I throw up. But no one believes me. They think I am creating a fuss.8221;

Madhuri listens to the problems faced by the patient and the care-giver. It is obvious that the former is uninterested in getting well. But the fear of becoming totally invalid works. States Madhuri, 8220;If you make no effort to eat, your chemotherapy will not work for you, but will destroy you. Do you want to become bedridden and immobile?8221;

At the end of the visit, Shah is convinced about the benefits of taking her meals and even promises to be regular. For her daughter, it is a major load off her back. 8220;Such patients will not listen to the family members because they feel they are against them. What Veena needed was someone who empathised with her and showed her the dangers of avoiding meals.8221;

She is now off to the office. Doesn8217;t such close contact with terminally-ill patients depress her? 8220;When I am sitting with them, yes, I do feel sad, but once I leave their homes, I stop thinking about it. If I didn8217;t, I would not able to function.8221; And tomorrow is another day, with more patients waiting for the healing touch!