Will
Khajuria”s Nana died today the 13th Dec 2006. With her death, all of my father’s generations are gone. It is now the turn of the generation next. How I wish, Rushi should have allowed me to lead the journey.
Lord, grant me a natural death and courage to welcome it when it comes. I wish my dead body should be cremated where I die. Rites should be simple, oriented towards welfare of “Daridra Narayan” and no observance of Jayanti or Death Anniversary.
Manaswi Sahoo, 13th Dec, 2006.
Will
I further wish that if I become invalid/unconscious or incapable to make decision about my treatment for any reason whatsoever, I shall not be shifted to any hospital or nursing home for treatment. I do not wish to survive for a moment with life support system in a hospital. I wish to die at home. My family members, relatives and friends should not suffer from any guilty conscience for not taking me to a hospital; they have bestowed upon me enough love, respect and care during my life time.
ManaswiSahoo, 8th May 2015
Ranjit- You will please ensure that my wishes are respected by all in the family including your mother.
ManaswiSahoo, 8th May 2015
Ps- Khajuria’s Nana was our father’s youngest sister.Rushi was my middle brother who died in 2004 from an incurable neuromuscular disease (ALS).Ranjit is my brother’s eldest son whose familystayed with my brother and Bhabi and took care of them. All my other nephews and niece live outside Sambalpur, our home town.
My eldest brother Sri ManaswiSahoo died on 11th, January 2018 after a brief illness. He was 83. I was there when he died. We were three brothers from a farmer family from Western Odisha.My brother had started as a clerk and retired as a superintendent of Indian Postal Service. He had financed my education from the 4th grade to all the way to my graduation from medical college. We were very close. He was my mentor.
After graduating from AIIMS, New Delhi in 1969, I moved to the United States for further training. I became a child specialist and specialist of the premature and sick newborns. Before retiring I practiced for 38 years in USA. Even though most sick babies survive,as a director of a large neonatal intensive care unit (NICU) I have seen hundreds of newborn babies die under our care. I have cried with many parents and attended many funerals. I have taught medical students, doctors and nurses about death and dying for more than 40 years. I have also written two books on the subject. I was also the managing director of a super specialty hospital in Bhubaneswar, India with a large number of adult intensive care beds. In my capacity as the managing director, I met many families who came to see me for concession on their hospital bills as they were unable to pay. During my hospital rounds I also met many families who were unwilling to discontinue futile care of their loved-one in spite of advice from their treating doctors.
A Brief History
As early as 2006(he was 72), my brother had accepted death and had made up his mind to die at home and not in a hospital or nursing home. In 2015, headded the second paragraph (we had talked about life support in January 2015 during my visit home from USA) to his will further clarifying his desire not to be placed on life support. He has told his wife, his sons, his close friends and me (the only doctor in the family) that he would like to die at home and not in a hospital.
My brother was 83 and had no chronic illnesses except for arthritis and loss of hearing in his left ear. He had no diabetes, heart disease, and chronic lung disease or kidney failure. His mind was sharp until about 2 weeks before his death. He was meeting people and doing the work of our family trust which he had done for more than 30 years.
My brother developed bluish discoloration in many parts of his skin and frequent nose bleedsaround 15th of Nov 2017. He was admitted to a hospital in Sambalpur (our home town) and was given multiple transfusions because of low hemoglobin and low platelets. He came home after three days of hospital stay. He was readmitted on 30th of December for high fever.His doctors suspected blood infection and on their advice, he was transferred to a specialty hospital in Bhubaneswar on the night of 31st. At the request of the family he was not admitted to the Intensive Care Unit but was given as private room (I was once the managing director of the hospital and my niece works there). He was conscious and received appropriate treatments. A bone marrow biopsy done on 3rd of January showed that he had blood cancer (chronic lymphocytic leukemia-a blood cancer of old people). He became semiconscious and delirious on 3rd of December. My wife and I reached Bhubaneswar from USA on 4th night and went straight to the hospital from the airport (our visit was planned since Nov). He did not recognize us. Next day we had a family conference with the doctors (cancer specialist, internist and neurosurgeon) and with their consent decided to bring my brother home to Sambalpur. After giving him one dose of the newest cancer medicine (we had planned to give him two more required doses at Sambalpur) we brought him home on 6th of January. Before his death, our immediate family members and relatives, neighbors, many of his friends and co-workers, many school teachers and students (our family trust has established many schools and hostels for girls near our birth village) and countless community members had an opportunity to say goodbye to him. He did not regain his consciousness and died on 11th afternoon in his own bed surrounded by his family. He was cremated the same night. Even though we all miss him very much, I feel that he had a good life and a good death. He was such a caring and nice person that I consider myself lucky to have been his brother.
What is a good death?
It is hard to define what a good death is. Each person must come to his or her own definition. Such definition is highly individual and changeable over one’s life time and over the course of an illness. Some of the attributes of a good death which most people agree are: being in control of one’s bodily functions including brain functions, being comfortable without significant pain, having a sense of closure about one’s life, being valued as a person, leaving a legacy and being cared for by family and if possible a quick death. In real life, most people are not that lucky to have a good death. Some people would say that there is no such thing as a “good death”- all deaths, are unnecessary, unwanted and unwelcome. But we cannot escape death. It will surely come.
How to prepare for death if you are getting old?
- Remember that we are all mortal. To accept that death is inevitable is the first step towards a good death.
- Consider “Old Age “as a chronic disease. Common causes of death in old age are- congestive heart failure from heart disease, stroke, cancer, diabetes and its complications and chronic obstructive lung disease (COPD) and pneumonia. Think about the level of medical intervention you want if you get sick.
- Remember, aggressive treatments to the very end results in expensive, painful and futile therapies. Risk of many treatments also increases with age. If you are sick, have a frank discussion with your doctors about your disease outcome, including your chance of dying from the disease. Encourage him to be frank. Many doctors try to sugar-coat the information in the mistaken belief that truth may hurt the patient. Don’t avoid discussing the cost of treatment as it may save your family some money.
- Pain can be control with proper medicines, but too much of it will make you drowsy and even unconscious.
- Consider palliative or comfort care or hospice care if you are suffering from a terminal illness. They are just different names for the same kind of comfort care. They are less expensive and most of the time you will be able to die at home, usually pain free or with bearable pain. Your doctor and hospital will be able to arrange for you if choose palliative care.
- Refusing to eat and drink is a practical, ethical and legal way to hasten death. Most studies show that two thirds of the fasting patients have no complaints of hunger at all. Only one third experience thirst which can be satisfied by using moist towels or moist swabs to wipe the lips and the mouth. Death by starvation is painless. If you decide to drink but not eat it will take you longer to die. Starving oneself to death is acceptable by most religions and most cultures. In 297BCE, Chandragupta Maurya gave up his throne to his son, became a Jain monk and starved himself to death.
- Most important of all, communicate your goals and wishes, to your immediate family members, doctors and friends. Put it in writing if you can. Designate a person you trust to be your health-care proxy, so that he/she will have legal power tomake decisions about your medical care in case you are unable to do so. If you have designated a health-care proxy in writing, his/her decisions about your medical care will be binding on the hospital and the doctors. Give a copy of your health-care proxy or will to the designated person and to your doctor.
Conclusion
To everything there is a season.
A time for every purpose under heaven;
A time to be born,
A time to die;
The Old Testament, Ecclesiastes 3:2
Death is certain for the born, Birth is certain for the dead,
You should not grieve for
What is unavoidable?
The Bhagavad-Gita
In our mind, we all know that one day we are all going to die. But most of us don’t want to think about it, talk about it or have anything to do with it, let alone plan for it. Dying can be much undignified- with soiled bed clothes with bodily fluids and foul languages- all not uncommon during the course of dying. Many times the outcome of medical treatment is uncertain. The survival can be short but the suffering can be great. Expense is another major problem for most people. It is important that you, the person who is old or someone who is suffering from serious illness, make your end-of –life care wishes known to your family, friends and doctors. Execute a health-care proxy and designate somebody you trust to make healthcare decisions on your behalf if for some reason you are unable to do so. Make peace with yourself and your family members. Say good bye.
Death rituals are important for the living not for the dead, even though we perform them in his/her name. They help us in our grieving.
My brother had left a very clear will but had not shown it to his son before he got sick. We found it on the 6th day after his death on the top drawer, on the first page of the top file. By that time my nephews had taken his ashes to Allahabad to be immersed in the Ganges. The invitations for the Ganga Bhoj were already sent. After reading his will I cried. It was so precise and so well written. In America I had executed a health- care proxy few years ago spending thousands of dollars in legal fee. My brother had done it in two short paragraphs. As the invitations were already sent we could not cancel the Ganga Bhoj but we trimmed the menu. We fed the poor after the death rituals were over.
In my opinion my brother had planned his death well. I am guessing that he was not thinking that he would die so soon, hence did not tell his sons about the location of his “Will”. He was looking forward to our visit in january2018. I feel that he had a good death by my definition. As for myself, I have put my financial affairs in order. I have executed a health-care proxy. I have given a copy to my eldest son who is the proxy holder. I personally believe that when one is ready to die, starving (both food and water) to death is a good way to die. It is legal everywhere. There are no complications and it is free. It is also painless. It may take some time based on your nutritional status but you will have a painless death.
I do not believe in the existence of a soul, after- life, heaven or hell or reincarnation. My body is like a turn garment (Gita).From the dust we come and to the dust we shall return (Bible). I have directed that my dead body be donated to the nearest medical school for students to dissect. I was fortunate to dissect somebody’s dead body during my medical training and I would like to return that favor.
I like what Churchill said “I am ready to meet my Maker. Whether my Maker is prepared for the ordeal of meeting me is another matter.”
The End