The Man of God
He looked quite striking, sitting on a chair in the corridor outside my room. He was wearing robes in the manner popularised by Vivekananda and more recently Adityanath. He had 3-4 rudrakhsha necklaces. I wondered what had made him visit a modern hospital instead of trusting in the ineffable wisdom of Ancient India.
I was somewhat surprised later when he was brought into my room and introduced to me as a VIP. He walked in regally and posed in the manner of the Shiva statue near the Delhi Airport. I suspect I was supposed to make a dive for his feet but I'm a bit dense about these matter of etiquette. I only figured out the protocol later.
He handed me a small box of Prasad, which, on later investigation turned out to be somewhat stale Barfi.
He then handed me some reports and told me the sad story. The patient was a relative/ friend/ devotee (I didn't quite pay attention to what he said since I was reading the reports). In any case, someone close to him. He broke into tears more than once during the discussion.
The patient was a US citizen and had been diagnosed with Hepatitis B many years ago. He had been treated with anti-virals but had already developed cirrhosis when diagnosed. The idea of liver transplant had been discussed but although he was decompensating in the form of developing ascites, his MELD score was low enough that he would not have got a liver from a deceased donor in the US. Living donor liver transplant was never discussed.
During his most recent follow up, he was found to have an advanced liver cancer, invading his portal vein. His liver function had also deteriorated and he now had intractable ascites requiring drainage every 4-5 days. I assume the tumour was missed during the last check up. Sometimes infiltrating liver cancers are not easy to see on the ultrasound.
Apart from the hospital in the US, he had also been seen in a well known hospital in Delhi. The answer everywhere was similar. There is not much we can do. Focus on comfort measures. Drain the ascites when it gets uncomfortable. He broke down into tears when I repeated what he had already been told.
He told me that the patient was now at an ashram where he was being treated with Ayurvedic remedies, including liberal doses of gomutra. Since the ashram was 4 hours from the nearest real hospital, paracentesis (draining the ascites to make him more comfortable) was problematic.
There are many things I wondered about during and after the encounter.
I was somewhat surprised later when he was brought into my room and introduced to me as a VIP. He walked in regally and posed in the manner of the Shiva statue near the Delhi Airport. I suspect I was supposed to make a dive for his feet but I'm a bit dense about these matter of etiquette. I only figured out the protocol later.
He handed me a small box of Prasad, which, on later investigation turned out to be somewhat stale Barfi.
He then handed me some reports and told me the sad story. The patient was a relative/ friend/ devotee (I didn't quite pay attention to what he said since I was reading the reports). In any case, someone close to him. He broke into tears more than once during the discussion.
The patient was a US citizen and had been diagnosed with Hepatitis B many years ago. He had been treated with anti-virals but had already developed cirrhosis when diagnosed. The idea of liver transplant had been discussed but although he was decompensating in the form of developing ascites, his MELD score was low enough that he would not have got a liver from a deceased donor in the US. Living donor liver transplant was never discussed.
During his most recent follow up, he was found to have an advanced liver cancer, invading his portal vein. His liver function had also deteriorated and he now had intractable ascites requiring drainage every 4-5 days. I assume the tumour was missed during the last check up. Sometimes infiltrating liver cancers are not easy to see on the ultrasound.
Apart from the hospital in the US, he had also been seen in a well known hospital in Delhi. The answer everywhere was similar. There is not much we can do. Focus on comfort measures. Drain the ascites when it gets uncomfortable. He broke down into tears when I repeated what he had already been told.
He told me that the patient was now at an ashram where he was being treated with Ayurvedic remedies, including liberal doses of gomutra. Since the ashram was 4 hours from the nearest real hospital, paracentesis (draining the ascites to make him more comfortable) was problematic.
There are many things I wondered about during and after the encounter.
- Healthcare in the US can be protocolized and often sub-optimal for the individual patient.
- Why would a devotee of Krishna and a pracharak of the Gita be distressed by the approach of death? For the soul, death is supposed to be like a change of clothing, no more.
- How can someone believe in two fundamentally contradictory things at the same time? He treats the unfortunate patient with cow urine but at the same time does the rounds of modern hospitals, hoping for a miracle cure?
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