Palliative Care -2 ( Personal Experience)

The following article is my Uncle’s personal notes about his experiences as a Volunteer- coordinator of Ottappalam Palliative care clinic. Actually it is part of a mail that my uncle mailed me and I’ve retained most of his words as in the mail.

When I heard about it first time:

It was about 4 years back when I had gone to a shop owned by a cousin of mine in Ottapalam, where two young men got introduced to me as hailing from a village nearby Vellinazhi ( Kerala). I did not understand the relevance of palliative care from them either, as some how or other I connected it to trauma units and I had no idea absolutely about the non-medical aspects of the deadly disease Cancer. I had assured them that I would get in touch with them later as I was going out of the country next day. The clinic with which these two young men were associated with, was functioning at Ottapalam itself and still very few people had heard about it.

Two years passed by, during which time, I had settled down in Ottapalam and was taking active interest in the socially beneficial activities of Ottapalam Welfare Trust. OWT was studying the feasibility of setting up a detection / diagnostic unit for cancer at Ottapalam and as a distant dream to set up curative facilities due to the relative large number of people affected by cancer coming to the free clinic we had set up there. On contacting a similar project at Ernakulam, we learnt that they had set up a palliative clinic there, which prompted us to get further details from Calicut Medical College and Institute of Palliative Medicine nearby. On reaching there, we had a first hand exposure to the way in which the outpatient clinic was functioning as also the relevance of such facilities to the society. We were bit surprised to learn that there was a clinic in Ottapalam itself, which is now functioning at Cherplacheri. This was none other than the unit about which the two young men referred to, in the previous para. The unit in the meanwhile had shifted to Cherplacheri from Ottapalam due to lack of public or community participation.

It took not much time afterwards for us at OWT to decide to start a unit in Ottapalam, guided and assisted by the Cherplacheri unit. We started with a once weekly nurses home care unit and started 7 months later a doctor's home care once a week. 8 months later we started outpatient clinic once a week.

What made me join:

The activities of Ottapalam Welfare Trust at that time were confined to such works, where my involvement was required for only an hour or so, just in an advisory capacity. A thought occurred to me; here I am doing nothing very concrete, spending time in reading articles and books and taking part in social activities related to my immediate relatives and neighborhood. I felt this is a field where I can do something, as anything done with a positive attitude would help many and so long as I enjoy reasonably good health I should be doing something like this. The doctors and a volunteer trainer who came from IPM Calicut and Manjeri, to conduct training sessions at Ottapalam, had stressed on one aspect that is at least one trustee of OWT should take active interest in the affairs, as otherwise many factors wouldn't be understood by the management. I decided that I should do it, as I might have only about 5 years before I cross the age of 70, by which time, my movements could get curtailed down. You can say that the prime motive factor in deciding that I should join the movement is my urge to be of help to the society at large, without involving in any politically oriented outfits, as is what is seen in Kerala State.

My experiences:

Two instances will never fade away from my memory.

One is the case of a woman patient, who was 79, suffering from acute stomach cancer and consequent pain, preventing her from taking any solid food. On our first home care visit to the home, we found the patient was wailing all the time, not giving a respite for her daughter for a minute, even going to toilet was impossible for the daughter, whose husband is both deaf and dumb, employed in the Amulya condiment factory near Ottapalam. Her only son's (aged 18) education had to be discontinued after 11th, due to financial constraints and was working in a STD booth nearby. The daughter was in a very distraught condition. The patient's son is working in Indian Army as an officer in Meghalaya and can't come on vacation when he needs to come. Seeing the situation in her home, I asked the nurse accompanying us, whom should we 'treat' now, the patient or her daughter. When we visited the same patient next week, the daughter was in very composed form and was clearing telling us to the effect that 'at last some one understands me". Her neighbors were definitely sympathetic to her, but did not know how and in what way she could be helped. We visited the home at least 6 times later and at all times, the daughter was composed. Ultimately, the patient met her inevitable end, but we had the satisfaction that we could make at least the daughter comfortable in her mother's last days.

Take the case of another 25 year old patient, suffering from paraplegia; damage occurred to the spinal cord due to a tree falling on her body, while she was walking to her home on 30th June '07, from the bus stop after a day's work as a sales girl. It suddenly rained on that day with heavy winds at the time of her return and an old, tall tree fell on her. Luckily (?!) two other people walking behind her noticed the tree falling and rescued her, from underneath the tree. She had tobe confined to her bed for more than 15 months after the initial treatments in hospitals who declared her suffering from damaged backbone and spinal cord. Nothing else could be done to bring her back to normal life. Prior to this unfortunate incident, she was engaged to get married. The prospective bridegroom is still interested in marrying her, in case she is in a position to walk. We at Ottapalam clinic, on hearing her plight started giving her the necessary care, such as changing the catheter tubes, dressing her bed sores etc. Our doctor had in the meanwhile heard of a clinic near Coimbatore who had offered to provide a special physiotherapy to similar patients (with some medical constraints to suit their methodology), in case no bed sores are there. Hence our doctor gave a crash course to the patient to cure her bed sores and later we took her to the clinic. After one and half month's treatment there, the patient was in a position to stand up and take a few steps with the help of a walker. The clinic had charged the patient nothing, as the expenses there are met by a charitable society. We need buy only the gadgets like a specially fitted wheel chair, calipers and walker. A benevolent lady and the local rotary club shared the costs and we could bring her back home after the first course. We have just taken her back to the clinic for the second phase of treatment, as was planned. One should see the relief and smiles we have been able to bring back to the faces of her poor mother and sisters to believe my story.

These two instances along with many other similar cases have proved to me the necessity of providing palliative care, as there is a large scope for such services to society, so long as we are in a position to render to our hapless brothers and sisters. Attitudes can make a lot of difference.

Not so pleasant experiences:

Since this system of home care has not been understood by most of the people, leave alone the close relatives of the patients who get assisted in taking care of them, unpleasant experiences can be understood better only after I describe what we are actually doing in the field.

What we are doing: (Volunteers):
I think I will be doing justice to myself only if I describe now 'what we are trying to do', as then only unpleasant experiences can be understood. You might conclude that what we are supposed to do is bit utopian, considering the enormity of the situation. Each patient has a different background, even if medical records may classify the disease as well as the extent of disease are just the same. Even if the physical conditions are the same, financial situation may be different. Even if financial background is also the same, the mental make up of the patient and his relatives or caretakers can be different. In a nutshell, we the volunteers are trying to offer solace to the patient in all the above spheres and hence each case will need be addressed as a distinctly separate and individualistic manner.

Hence in an ideal case, each patient will need to be taken care of by a single volunteer. It is just impossible to get such large number of volunteers, one for each patient. As per the statistics available for Kerala, each panchayath of population 30 to 35000 will have 50 to 100 patients to be taken care of. To get such large number of volunteers with inclination to do voluntary social work is next to impossible, considering the ground realities (requirement of employment, single unit families, commitments to the family, vocations, individual priorities etc). This makes it essential for those volunteers who are inclined and can afford to do social work to take care of more patients, which itself will reduce the effectiveness of each volunteer, both qualitatively and quantitatively.

Volunteers are expected to visit patients regularly to ensure they take the medicines regularly as prescribed by the doctor, to follow the changes in the patient, (level of pain and other physical conditions), to ensure that the patient's relatives are dressing the wounds due to bed sores, keep a schedule of the dates when the catheter tube is to be changed etc. In most of the case, the medicines will not be of curative type, but those required to limit the discomfiture the patient is facing.

Volunteers are also expected to monitor that the education of children of the patients does not get affected, nor they can get two square meals a day. Since most of the patients and their relatives would have understood that they were in the clutches of a killer disease, moral and psychological support could be the most important sphere, volunteers will need to address.

When a patient is declared as suffering from incurable disease, he could be subject to social isolation, as many of his old friends and relatives won't know how to react and console him. As time passes by, he would be forgotten by the society around him and that feeling itself is adequate to 'kill' man. We had nursed a patient, who wanted company of an understanding person for about an hour daily, as none was going to his house for days together. Volunteers can do a lot in such cases.

Financial assistance will be sought by most of the patients, particularly those who have had to undergo costly treatments like chemotherapy and radiation. Even if the patients belong to well-to-do class, they would have exhausted their resources considerably if they have to undergo these costly treatments, apart from the indirect costs involved. Distributing funds cannot solve the problems unless the clinic has access to unlimited resources which will not be the case at all. Distinguishing between genuine and ingenuine demands will pose another difficult problem. One will not be able to choose between patients as all patients approaching your clinic will need be assisted equitably and uniformly.

Further, social pressures from well meaning relations and friends would force them to spend on ineffective treatments and procedures. The patients and their close relations won't know how to take a practical and correct decision under social pressures. To recall a recent incident, a close relative of one of our volunteers was diagnosed as suffering from cancer which had spread all over the body after getting malignant. The patient had undergone all the three accepted modes of treatment in well known hospitals. Hoping against hopes he succumbed to pressures and had sought treatments from hereditary physicians who had no formal education, involving herbals and other concoctions which are not supported by adequate documentation or research. He was reluctant to keep me in confidence about such treatments as he himself was not convinced about the effectiveness of such treatments. But well meaning relations forced him to meet such quacks as he had lost hopes on the whole case. Even if I had known, I do not think I could have dissuaded him from going in for such treatments, as it will be extremely difficult to answer his question, why not try this method, as other methods have been pronounced ineffective. He was virtually looking for a miracle. (Needless to mention, the patient died within a couple of days at the age of 37, even before the first dose of the quack could be administered. The patient left behind his wife for 8 years and a child aged 4).

The psychological aspects will be the most difficult issues to be dealt with. There will be cases when a patient suffering from acute pain asks you to provide medicines for terminating his life and the pain. A volunteer can not accept such a request both on legal and moral grounds. How does one address such a situation? There is an added risk if the volunteer considers such request even sympathetically. Unless care is taken, the patient would treat the volunteer as his enemy who would like the patient to die, if at all the volunteer offers to assist him, out of sympathy on seeing his suffering.

It is also possible that the patient could get spiritually upset. If he is a believer in god, he might start questioning why he was chosen to suffer by the same god, in whom he had all the faith. Even if the patient is an atheist, he could start doubting whether he had been punished for being an atheist. Factors vary from individual to individual.

It is very essential that volunteers should undergo serious training to be able to handle difficult situations. Common sense alone will not be adequate to handle tricky situations.

While medical assistance is the first one to start with, the same should be followed up with assistance on social, financial, psychological and spiritual aspects. These factors cannot be easily quantified as in the case of medical assistance.

The only way to understand the situation is to take part in home care visits of nurses and volunteers. The actual condition of the patient, in all the above mentioned 5 aspects, can be understood during such visits. If the patient visits a clinic, aspects concerning the ailment only could be understood. This change in understanding can make a qualitative difference in the caliber of the care that can be given.

You might think whether all volunteers will need to do all the above. Not at all. There are so many indirect things one can do, without even seeing a patient. For example, some volunteers may be good in fund collection. They can do it as a part of their other vocations. They need not even visit a patient. But he will need to take part in home care visits initially to understand the gravity of situation, as that would make him more effective in fund collection. The premise of the system is that people of each village or locality should be able to take care of the patients in their locality. One can find the field of his service if he keeps his eyes and mind open, with a positive attitude.

Nurses:

Nurses provide the medical care such as dressing of wounds (bed sores), changing catheter tubes at regular intervals, dispense medicines to combat vomiting, pains, constipation etc., in short keep a track of all medical aspects. Nurse' home care visits are as important as more frequent and regular home visits by volunteers, which provide the basis for nurses' actions under the guidance of doctors.

Doctors:

Considering the limited availability of doctors (who have undergone special training in palliative care), home care visits by doctors are far less than what is required. They will need however visit more critical patients with a view to assess the type of care that could be given, apart from boosting the morale of the patients and their relatives.

Unpleasant experiences:

Since the care is being given to those patients for whom curative treatments have become ineffective, thereby declaring them as terminal patients, death rate will naturally be very high. We are only making the last days of such patients more endurable. Hence there could be many occasions, which might force one to think that we could have done better to serve such patients.

In the preceding paragraphs, I had already mentioned one or two instances which have been very unpleasant for me which left the feeling with me that I have not done what I was supposed to do. The most difficult situation was when one ex-volunteer of our clinic came to my home and started sobbing uncontrollably to inform me that his relative was declared terminal by the specialist hospital which informed the patient that no further treatment was possible and he could now go home. In fact I had information from the case history that, that was the case which I could not inform my friend at the right time. I virtually feared that my friend won't believe me, not that such information at that stage would have made any qualitative difference. The end was very well in sight, but to accept the same, was way beyond the relative.

How to break the bad news (BBN) remains as an enigma for any volunteer of palliative clinic as well as Doctors. Patients and their relatives would believe a doctor more than anybody else and hence the onus of breaking the bad news rests with the doctors more often than the volunteers. Doctors may not be questioned by the patients or their relatives, but volunteers could be questioned and hence they have to be more careful on this issue.

Hurdles:

The first hurdle which comes in the way of extending care is the stigma associated with incurable diseases by the patients and his relatives. Pressures built up by financial and relationship factors complicate the issue. We have come across patients who are marginalized in their homes by his own siblings. Sometimes it will be unbelievable to imagine that people can behave in such cruel and inhuman manner when someone close to them get declared as suffering from incurable disease.

Constraints due to job/employment etc. on the part of the relatives can leave the patients unattended to for days. Since home nursing is not considered as a part of home care now, this adds a constraint to the system, as ensuring proper care at home becomes difficult.

I have come across at least one case in which the marriage proposal for the daughter of a patient got fizzled out when it was known that the father had become terminally ill. People are still ignorant when it comes to certain diseases, which some consider as hereditary.

There was a case reported in which the principal of a college refused a request for blood for a terminally ill patient saying that he can advise his students to donate blood for only those patients who are not terminally ill. Ignorance pervades through educated people as well.

General apathy is another important hurdle we are facing everyday. While everyone lauds the efforts, they expect others to take the initiative due to a variety of factors.

Maintaining level of optimism:

The feeling of gratitude expressed by the relatives of patients in their hour of need and the resulting pleasure of happiness that a helping hand could be given to the needy keep us going in our efforts to be of assistance to poor and needy, in spite of the various odds faced by us.

The author of the above article Mr. M.P. Ravindranathan may be contacted at rvndrn@gmail.com

Palliative Care-1

Sometime last month I came across an extensive write up about Palliative Care in The Hindu Sunday Supplement . I've always had this concept of Palliative care stuck in my mind when I first heard about it. I think it was when some physicians from Kottakkal were sent for training to Kozhikkode years ago. The point of interest being purely and simply some kind of empathy. As one advances in age, one tends to think of many uncertainities of life and more about being able to handle it with some semblance of serenity and maturity. After reading the article I was reminded of my uncle and aunt who are very much involved in Palliative Care Services in their home town.
I mailed him asking him to send me articles regarding Palliative Care in general and his experiences in particular. He readily obliged and I’m hoping to post his article mostly verbatim with his permission here .

Apart from personal curiosity, I thought that his words might prove to be enlightening and inspiring to many those who are not fully aware of the impact and importance of all that Palliative care entails. I think it to be of increasing relevance in today's society in more ways than one.





What is Palliative care?

Objective of this write up

The objective of this brief write up is to generate awareness about Palliative care to those who had not heard about it. It is not the intention to describe all aspects of the same as it would take considerable time and personal involvement to get to know the various aspects.

How the concept of Palliative care has originated?

Diseases can be classified broadly into two categories, those which are curable and those which are not curable. Curable diseases can be handled by the existing system of medical care, both in public and private sectors. However, the medical services offered by the state and by private hospitals do not take care of patients with incurable diseases, who deserve sympathy and understanding, as they are left to the mercy of the family which often finds it extremely difficult to attend to them. In most of the cases, such patients get bed ridden permanently causing anxiety; feeling of helplessness, financial strains etc., with the stark truth of only death as the only reliever, unsettling their family in all respects. The need for palliative care arises to take care of these “incurable” patients.

Let me start with the background on how the concept of Palliative care had its genesis. The primary reason is the fact that nowadays medical profession has become very much doctor and equipment oriented. No doctor goes to the patients; patients have to go to the doctors or hospitals. And the problem has been compounded due to the fact that treatments have become very equipment based, with lot of medical electronics equipment to be used right from the stage of diagnosis. Without using these equipments which are costly and hence beyond the reach of even very rich patients, who also have to go to hospitals or even clinics, no treatment is performed nowadays. This adds a lot to the strain even to those patients who are not permanently bed ridden. Then one can imagine how much will be the difficulties faced by permanently bed ridden patients who have to be transported to the doctors.

Another reason which has given momentum to this concept is that during the last 30 to 40 years, joint family system has vanished due to a variety of factors and single unit family system has come to stay. While both systems have their advantages and disadvantages, single unit family system has thrown open a peculiar problem where in old parents, who suffer from incurable diseases have been left to the mercy of their siblings who often ignore their own parents, may be due to their own employment or profession, financial constraints or any other social factors, which cannot be justified when viewed from a human angle.

The concept of palliative care was propounded by a well known nurse, Ms Cicily Saunders in UK in 1960. In western countries, the service has been called “HOSPICE”, with specialty hospitals as the centre of action. In India, this service had its beginnings in 1990 in ‘Shanthi Avedhana ashramam’ near Bombay. However a system based on hospitals is not suitable to third world countries like India. In Kerala, the first Palliative care clinic commenced functioning in 1993 in Kozhikode Medical College. When it was noticed that patients from far away placed cannot reach the hospital, localized clinics were conceived. The first clinic with community participation was established in 1993 in Nilambur, Malappuram district. Such clinics turned out to be very popular thanks to community participation, which led to the establishment of Neighborhood Network in Palliative Care (NNPC in short). Now, in Malappuram district alone, there are 25 such clinics. In the other districts of North Kerala, Calicut, Wayanad, Kannujr, Kasargod and Palakkad, such community oriented clinics are very active. There are at present more than 3000 trained volunteers in Malappuram district alone. More than 2000 new patients become the beneficiaries of palliative care, in each year in Malappuram district. Statistics show that more patients require this care and service all over Kerala.

It must also be mentioned here that the Malappuram initiative has become so well known that nurses and volunteers from other third world countries are taking training in Malappuram and Kozhikode clinics.

Who needs palliative care?

One can appreciate that non curable diseases like some types of cancer, damage to backbone and hence to spinal cord, brain damage due to tumors or stoppage of blood circulation, HIV positive patients, geriatric patients, cuts and injuries which do not respond to any medicine, suffering from high intensity pains etc. force many patients to get bed ridden, which disable them to perform even the basic necessities of life. They will need assistance even for taking food or going to toilets etc, which will have to be performed in bed.

In most of these cases, the patient gets declared as suffering from incurable after undergoing difficult, costly and time consuming investigations, treatments necessitating hospitalization for longer periods etc. These break the mental and physical morale of most of the patients and their siblings. Most of these patients break down in the face of the realities of life, when the doctor or hospital advises them that they can now go back to their homes without any further treatment possible.

Even though medical treatment to the citizens is recognized as a responsibility of the state, can one expect attention to patients falling under this category to get solace from the government? Here comes the need for community participation, only with which some relief can be given to these patients.

Problems faced by permanently bed ridden patients

1. Physical problems:

Continuous medication will be required to contain the physical problems. Medication will need to take into account peculiar and individual problems of each patient and conditions of his family. Injuries will need dressing up regularly. Who will do it, as nowadays even trained nurses do not visit homes.

2. Financial problems:

Treatment in hospitals is an expensive affair. By the time the hospital sends back the patients declaring the disease as incurable, the patient and his family would have spent a very large amount by way of direct and indirect expenses. This could even mean starvation and stoppage of education to their children and a host of other problems, thereby virtually breaking the family into doom.

3. Social problems:

Confinement to the bed forces the patient to cut all social contacts, thereby forcing him to withdraw to himself. He has to depend on others for each and everything. This gives rise to a host of problems in his life. He starts feeling that he is an unwanted being in this world and a liability for all, including his close relatives.

4. Psychological problems:

The factors explained in the previous paragraphs leads to psychological problems. One can visualize the problems that will be encountered.

5. Spiritual aspects:

There could be cases where the patient can start thinking on his existence and spiritual aspects coming to the fore, when faced with a realization that there is no cure for his ailment and he is forced to start visualizing his end worrying about the safety and existence of his own family etc.

One can realize that there are no medical remedies to the above problems except possibly the first one. However with the body and psyche so much inter-related the patient and his family find that they are in a no-win situation. Doctors can attend only 20% of the problems faced by the patient. The community can at least try to attend to the rest of the problems.

What can the Community do for such patients ?

In fact there will not be any situation in which nothing can be done to help such patients. There is no limit to the care that can be given to them. What is more important is that the community should have ‘eyes and ears’ and a positive attitude to help such unfortunate patients. Rest will follow.

Members of the community can organize the efforts to provide the care to the needy. Trained volunteers provide the leadership that is required for such efforts. Required funds, medicines, food, cloth etc. are all collected by the community. Outpatient clinics and home care visits are organized by these volunteers, who find out the patients who need such care. They visit the houses of the patients frequently to understand the specific needs of the patients.

Doctors and nurses who have undergone specific training in palliative care provide the medical care that is required. They attend to the patients (who can travel to the out patient clinics) and bystanders / relatives (of patients who cannot travel), who are given the necessary medicines with instructions. Depending on the number of patients, the out patient clinics function on one or two days a week. Home care visits are undertaken by nurses and doctors (depending on the availability) at regular periods to provide the medical help required and to understand the actual conditions of the patient and family.

Since the patients have been declared as incurable, it is practically impossible to cure them completely or alleviate all physical problems. The objective of palliative care is to reduce the problems which can be solved, as much as possible. The objective also includes enabling the patient and relatives to solve their problems as also provide required medicines and other materials and advise them how to use them, besides overseeing whether the care is utilized properly. For example, where dressing of wounds is required, the relative or bystander can be trained in doing the same. Similarly they can be taught how to maintain water beds etc.

Home care - the distinct feature of palliative care

What makes palliative care different from other treatments is the home care. Doctors and nurses provide only the medical care to the physical problems of only those patients who suffer most, as often it is impossible to visit all patients, due to the non availability of trained doctors. Volunteers provide the link with all patients. There are three types of home care, one is home care conducted by doctor and nurse, second is the home care conducted by volunteers under the leadership of trained nurses and third by local volunteers by visiting the homes of the patients.

The three tier home care helps understand the conditions of the patients completely thereby enabling the clinic to provide all care needed by the patient. This helps develop contact with the family which gets self confidence in caring the patient. This also helps the family escape the social aloofness.

The funds required for the efforts are found from small contributions, money collection boxes kept in shops and public places, monthly contributions from public etc. Many village panchayaths or other local govt. institutions such as district panchayaths provide medicines. Assistance or grants from government is not available presently. (the president of Malappuram district Panchayath took part in the nurses home care in a clinic once and his feelings forced him to set apart a very considerable amount for helping the palliative clinics in his district).

Volunteers - the backbone of Palliative Care

Every one can contribute his mite in these efforts. Every form of positive work is welcome, right from locating a patient and linking them with the nearest clinic, providing physical or monetary help, linking the patient with governmental agencies for getting documentation that can help them get disability pension etc.

No educational qualification is required to become a volunteer. What is needed is only a positive attitude to help others in distress. There are so many volunteers who cannot read or write well, or who are not financially sound. They can be of any religion or caste or political affiliation. All those who are interested in alleviating the problems of fellow human beings can become volunteers. It is not a work that is required to be done affecting our regular occupation. Those who can spare a couple of hours in a week in their leisure can contribute a lot by becoming volunteers.

In short, volunteers are the backbone of this service oriented system of care. Let me end this note with a well known quotation by Mother Theresa.

“It is not how much we do, but how much love we put in the doing. It is not how much we give, but how much love we put in the giving”

----------oOo----------



(Note prepared by: M. P. Ravindranathan, volunteer-coordinator of Ottapalam Palliative care clinic, Palakkad district, a division of Ottapalam Welfare Trust. Please visit their website: www.owelt.org.in to get to know more about this trust and its activities)

Into that heaven of freedom, my Father, let my country awake?

( To those faceless entities who unleashed a trail of death)

Are you Happy? Are you smiling? Are you laughing?

The sight of the carnage, the panic, the madness

The terror, the blank gaze…

The people running helter skelter

The blood, the cries, the wails

They soothe your injured souls?

Are you pacified?

Are you celebrating?

Backslapping one another

For a deed well accomplished?

You’ve achieved what you sought?

No? more to do?

More carnage, more destruction in your to do list?

A couple of men gone?

So what – you’re looking at the larger picture?

So much of colour, so much of sound too

Did you sleep soundly ?

Oh no, more plans, more strategies to work out…

So much more to be done…

There is no doubt in your conscience right?

Everything is just right , just how it should be?

WHERE the mind is without fear and the head is held high

Where knowledge is free

Where the world has not been broken up into fragments

By narrow domestic walls

Where words come out from the depth of truth

Where tireless striving stretches its arms towards perfection

Where the clear stream of reason has not lost its way

Into the dreary desert sand of dead habit

Where the mind is led forward by thee

Into ever-widening thought and action

Into that heaven of freedom, my Father, let my country awake.

Sorry Sir..everything has gone awry...

there is only fear, there is only anguish...

and the fragments are so tiny and shorn far apart-

Haven? Freedom? Mere sounds...

I cannot watch and yet I cannot but watch...where and when will all this end?

http://mumbaihelp.blogspot.com/

A couple of years ago, we had travelled to Mumbai in a group. We were going sightseeing one day. My husband and son could not accompany the rest of us because they took ill. I joined the others leaving my heart behind in the boarding where we were put up. We took the Mumbai darshan bus. We stopped at The Gateway of India. As we were walking , I went up with my cousin to the public telephone booth located below The Taj. I was frantically trying to reach my husband's mobile and I could not. One of the watchmen stepped forward and asked me to make the call from his cell. I spoke to my husband and reassured about his health, thanked the person and came away. I had just about crossed the road when I heard somebody calling out to get my attention. It was the same person - he was holding out his cell to me. Apparently my husband, not knowing whose cell I was calling from had called back and this person had come running to allow me to attend the call.

I thanked him profusely...

I'm thinking of him today and of many others...

Borrowing Tags

Tag :1

Do you remember how you developed a love for reading?

My maternal uncle who used to live with us those days , used to gift me a book for my birthdays- and I remember waiting eagerly for the book and then reading it at one go as soon as I laid my hands on it. I would find my amma always with a book whenever she was free. Reading developed naturally without too much of effort.

What are some books you read as a child?

It used to be Enid Blyton most of the time. Then achhan used to buy Amar Chitra Katha regularly from the little shop near V.T station. We used to bind the issues. I would never tire of reading them over and over again. I graduated to Nancy drew, Agatha Christie. I used to like Charles Dickens when I was older. I enjoyed K.M Munshi’s Krishnavataram series.

What is your favourite genre?

Fiction mostly. Nowadays a bit on the spiritual line. I don’t relish travelogues, but I sort of enjoyed Ruskin Bond’s 'Tales of the open Road' recently because it not in the travelogue format. I used to enjoy horror but not any more. I like to get hold of a mushy romance now and then. I like R.K. Narayan. I’ve relished reading different expositions on The Mahabharatha- fictionalized versions- these were mostly in Malayalam. I used t o enjoy P.G.Wodehouse but now, though I don’t mind reading them once in a way, I find the humour contrived and grating!

Do you have a favourite novel?

Oh yes, many…let me list a few that comes to mind at this moment:

As a child I loved Ruby Ferguson’s “Jill’s Gymkhana”

Nikos Kazantsakis- Zorba The Greek- it has spoken to me differently at different times amazing me each time.

M.T.Vasudevan Nair’s ‘Randaam Oozham’- There’s a real good English ‘recreation’ online .

V.T.Nandakumar’s “Ente Karnan”

Kuttikrishna Marar’s ‘Bharatha Paryatanam’

Alex Haley’s ‘Roots’

Paulo Coelho’s ‘Eleven Minutes’

Many many more…

Where do you usually read?

Anything other than cookery recipe books , travelogues, Science fiction. I get lost in Geographical/ spatial details.

Do you usually have more than one book you are reading at a time?

No, I stick to only one book at a time. I think I might get confused otherwise.

Do you read nonfiction in a different way or place than you read fiction?

No I don’t think so- or may be when I read non fiction I sometimes go back and re -read, sometimes take down lines in my diary.

Do you buy most of the books you read, or borrow them, or check them out of the library?

I busy most of my books, though I’ve borrowed too- and then ended up buying a copy if I liked it too much.

Do you keep most of the books you buy? If not, what do you do with them?
I keep all the books I buy. I find it difficult to give away books even those that I don’t like.

If you have children, what are some of the favorite books you have shared with them? Were they some of the same ones you read as a child?
The books that my brother and me read as a child are all safely preserved in my parents home in Kerala and my sons have read most of them whenever they visit them.

What are you reading now?

I’m reading Malcolm Gladwell’s ‘Blink’- its not too engrossing and I’m kind of dawdling through it.

Do you keep a TBR (to be read) list?
Yes, I’ve such a list but no idea if I’ll ever get them.

What books would you like to reread?

Most of the ones I’ve read.

Who are your favourite authors?
M.T.Vasudevan Nair. I’ve written to him and received a reply too which is a treasured possession.

Kuttikrishna Maraar.

Tag 2

My oldest memory:

I’ve many memories but am not sure which is the earliest. Perhaps the one of falling and hurting myself in our Bombay flat- bleeding profusely and being taken to the hospital. A neighbour and friend by the name of Sunita was with me. The scar remains on my forehead to this day.

Ten years ago:

November 1998? Just ordinary days. No particular memory that has stuck.

My first thought this morning

‘better get up…’

If you built a time capsule, what would it contain:

My family, my pc.

This year:

Eventful.

14 years from now:

I’d be 55 then. Hopefully someone with serenity, tolerance, acceptance, good health and lots, lots of emotional and mental strength . Someone who is not afraid about the uncertanities of Life.

Taking a Bow

Me an honest Blogger? HHG has graciously awarded me with this title- An Honest Blogger. Dear HHG, receiving any award is always an honour- and when it comes from someone whom one respects and admires, it becomes even more special. Thank you so much HHG. But it has put me into an introspection mode.

HONEST- is one adjective that I’ve wondered about with regard to my posts. Not that I’ve been dishonest on my posts. I can confidently say that while I’ve never been dishonest here on my patch of cyberspace, I must add that I’ve had second thoughts at times, have pruned words before pressing the ‘post' button. On one occasion, I remember I went back and deleted an entire post. So whatever stays here, while is true, wholly true, I’ve never ventured to express anything that I’m uncomfortable sharing on a public forum.
Why do I do this? I’m not sure I’ve a clear answer, but even in my real life, except within my closest circle, I tend to be very careful about how I express myself. I’m extremely wary about ruffling feathers, rubbing people the wrong way. I’m mostly a fence sitter , a spectator simply because excited voices raised in dissent makes me extremely uncomfortable. I might express my difference of opinion politely once, and stop there without pursuing it. If the ambience is very vehement, I don’t take the effort even once. However I must add that I’m rarely convinced or converted away from my stance. I’ve been given to understand that I can be quite stubborn that way. I’ve wondered about the reasons I choose to keep my opinions to myself. Am I afraid of unpleasant, unfavourable reactions? Could be.

I’ve talked about my blog persona before here.

Getting back to the award tag, These are the rules:

1. The winner can put the logo on their blog
2. Link the person you received your award from
3. Nominate at least 7 other blogs.
4. Put links of those blogs on yours.
5. Leave a message on the blogs you’ve nominated.

Most of the bloggers I might have described as honest have been honoured already, so I’ll just mention some of the bloggers whose posts I find endearingly honest .

Akeeyu, Biswanath Ghosh, Punds, Asuph, like a feather, Libranlover, The Box

Disconnected thoughts

I saw “Jaane tu jaane na” when we had gone to Bangalore in Aug. Overall cute movie, but I was not as enamoured as I was with “Dil chahta hai”. In fact another story on similar lines- ‘Niram” in Malayalam- (which incidentally has been remade in Tamil too- with vijay and shalini- I forget the name of the movie) I had liked better- However, the hero is cute and some of the dialogue was brilliant.

Saw “Memoirs of Geisha” the other day- had heard so much about the book and the movie and so when I saw in the papers that they were relaying it I resolved to see it. Besides, I was free with no NIE sessions because it’s the quarterly exam season. As I switched on the T.V. “Philadelphia” was coming to an end- that movie about an aids victim - It was Tom Hanks as the Aids victim and he has turned out a marvelous performance as usual- quite painful and depressing to watch him crumbling bit by bit.

Memoirs of Geisha began- and God Disposes- or rather the EB disposes- the power cut commences simultaneously – resumed after the mandatory 1 hour. Saw what was left of it. Neat movie. Browsed through the net to get an insight into the whole movie. Poignant and powerful performances.

Listening to Muhammad Rafi songs- Ehsaan tera hoga mujh par

Dil chahta hai wo kehne do…mujhe tumse muhobbat ho gayi hai

Mujhe palkon ke chhaaon mein rehne do …

The way Rafi twirls and enunciates the word ‘Mohabbat’ tugs at the soul…

I listen to Chhaayageet daily on Vividh Bhathi on my cell - followed by ‘Aap ki farmaayish’- 10.00 – 11 p.m-mostly old melodies rustling up sleeping memories.

Y’day, saw ‘Thanmaatra’ – a Malayalam film based on the progression (regression) of an Alzheimer’s victim. This role is played by Mohanlal- a government official- a caring husband and father- notices his failing memory with some alarm. Gradually he loses all his faculties, left with random snatches of incoherent memories- how his family struggles to cope- so painful to watch especially those scenes where he for fractions of moments realizes his predicament- the helplessness, the deep pain- is heart wrenching to watch. I was sobbing away – I had been wanting to see this movie because I had heard it was brilliantly made, Mohanlal has done a wonderful job, ( tho I don’t think mannerisms like slurring and putting one’s tongue out are symptoms of Alzheimers) and so has the others who have played the roles of his caring wife, son, father, and close friend. Though I relished the technical brilliance of the film, I was totally sunk in depression by the end.

Really scary- one is left wondering about the consequences of loss of memory- one is after all an amalgam of experiences, memories and conditioned thinking- if that is gone, is not one reduced to an empty shell? Reminds me of an earlier post of mine here.

Lullaby memories- A repost

( The following is a repost of an old blog- dated January 18 '05.I was reminded of it when I read a post on Mad Momma's page. Since I blog very sporadically these days, thought of simply doing a cut and paste).


Today I was reminded of the time when I used to sing lullabies to my kids when they were babies- I would sit on the floor, my back resting on the wall behind, my legs out stretched with a pillow, and my baby , I would lay on my extended legs- I would have decided it was time for him to go to sleep, because I had unfinished chores waiting- and thus having my baby gently tucked up on my out stretched legs, my hands clasping the little palms, I would set forth belting out all the songs I knew- not necessarily lullabies always- any melodys would serve the purpose as far as I was concerned-( I remember songs like chura liya tumne jo dil ko too featured in this lullaby repertoire- ) and all the while I’d be rocking the baby to and fro on my legs- the songs would be in Malayalam, Hindi and a few in broken Tamil too- when I was at a loss for the lyrics- la- la- la- la would be substituted- Needless to say I forgot the hapless neighbours, but got to say to their credit, never received a complaint or a notice to quit our flat- the lullaby concert would go on and on for more than an hour sometimes, simply because I was enjoying listening to my voice to the hilt, irrespective of whether my baby was asleep or awake. There would be little breaks in between because my baby would be gazing wide eyed at me- sleep farthest from his eyes- and I would have to molly coddle him, talk to him in gibberish to which he would gurgle back heartily- and sometimes even reply back in gibberish- and after our little conversation I would go back to my attempt to singing him to sleep.

And finally when my feet had gone to sleep too, and I was reminded of the piled up vessels in the sink, the half cooked sabji in the cooker, I would stealthily pick my sleeping baby, tuck him cosily in his bed, with pillows all around for added cosiness, kiss the chubby cheek, gaze fondly at my sleeping angel for some precious moments and finally tiptoe to my kitchen to finish my chores. Less than five minutes would have passed and my jigar ka tukda would be wide awake bawling his head off for all he was worth- all efforts of a good hour and more gone up in smoke- awww… and if the door bell buzzed when my baby was sleeping- I used to get soooo angry…

And then there were the times when I would have run out of my stock of songs and my baby would still be wide awake, and I would have been exhausted… he would have decided that he had enough of the drama/concert and he would give me a solid yelling and I had to resort to other means of placating him…


And today my elder “baby” is almost *15, he is sporting an incipient moustache- his voice cracks and squeaks, especially when he is angry, and we end up laughing together- and I think I’ve forgotten to sing…

( * My baby is now 18 years and far away in a hostel ).

The point of no return.

THE POINT OF NO RETURN

HORIZON HUES

Dabbling after a long time...

Horizon Hues

Frozen Memories

On April 30th, we boarded the train to Delhi. ‘We’ included our family and 3 other families. Almost every year we visited some places in India during the summer hols. This year we were planning to visit Delhi, Agra, Mathura, Brindavan, Amritsar, Manali. Was I thrilled about the prospect? Was I looking forward to the trip eagerly? Well, actually the answer would be a very hesitant yes. I’m not a keen traveler at all. Give me my home, a book and Music I like and I’ve Paradise right within my clasp. However my husband and sons were mighty excited about the trip and that alone was reason enough for me to go along and I was determined to be at my cheerful best. The thing is that I’m too wary about travel comfort, hygiene, food quality, restroom facilities. Travel can be fine if all these factors are ensured but when one is in a mixed company its not always possible to stick to one’s idea of such matters. Our friends are very good company, most helpful, cooperative and adjusting but well, they go pretty easy on the aspects that I was concerned about.

I was traveling by a/c for the first time and the trip began comfortably. Last year we had gone by the non a/c and we got practically roasted as we passed through the Andhra terrains. This time I was swathed in sweaters inside the train while it was sweltering outside! I smiled, I laughed, I sang, played with the others but was I actually enjoying? I’m not sure. It was like I had left my soul behind. I don’t know why I’m like this?

We got introduced to a young American couple- a doctor and a professor who had chosen to come and work in India. They were very enthused by their experiences and shared their thoughts with us. Now they were returning home after visiting Agra and Manali.

We reached Delhi on 2nd noon. The heat outside hit us like razor blades. We refreshed ourselves at the guest house we were to stay in and then proceeded to Akshardham. I was a trifle disappointed that we could not make time to visit the Hall of Values- 50 minutes, Neelkantha darsan-40 minutes, Sanskruti Vihar boat ride. What then did we see there? We walked around , sometimes slowly and in a hurry at other times, gazed at the exquisite elephant sculptures. The place was sprawling and quite impressive and yet I remained somewhat untouched. As everyone around me raved , I was wondering what was it that I was looking for?

From there we went to the India Gate. I had been there years ago with my parents and brother.. I remember being touched by the thought of the soldiers who had laid down their lives for the freedom that we were now enjoying. I was wondering if our children realized the significance. As I type these words, I’m thinking that I wanted solitude- to be alone with all the sights around me. I was incapable of enjoying to the full the sights and the places in a lively group. However, one thing I realize that but for this group we would never have made the trip in the first place. We sat on the grounds as darkness was first setting in and a girl came over asking us if we wanted to apply hennah on our palms. We let her do our palms and she did it pretty fast. I participated in every everything but somehow felt strangely disconnected from everything.

Next day we went to Agra. TAJ MAHAL….As I beheld the all too familiar splendour standing out against the blazing skies, I was desperately trying to summon some kind of feeling…We gingerly traipsed along the sizzling mats into the cool interior of the mausoleum. Time management was proving to be a detrimental issue and so we jostled through the crowds. There were solitary moments when I was beckoned by the legend of the Taj, but there was no time to pause. We were scattered, the men were in the front as I sauntered up to my husband who was enjoying a joke with his friends. I whispered to him that I wanted to come back here on some cool twilight evening, sit down and simply gaze up at this sight. My husband smiled and said we’ll come again. Yeah.Sure.

We roamed the precincts and inner sanctum of the Agra fort when the sun was at the summit. The guide’s description made the tour somewhat bearable. But we were all so exhausted and thirsty because of the heat. I kept remembering scenes from Jodha Akbar and kept seeing Hrithik and Aishwarya in the locations in my mind's eye! I kept musing how everything would’ve been so much different if only it wasn’t so hot and we had lots of time to saunter to our hearts content.

From there we raced to Mathura- the place of Lord Krishna’s birth. I fervently tried to ignore the merciless heat, the oppressing thirst and my throbbing temples.I was determined to smile through it all. Only now as I type these words I’m reliving the sheer truth of it all.

On 4th, we boarded the train to Kiratpur. I was hearing the name for the first time .( Incidentally, I happened to see Veer Zaara after our return and when I heard Kiratpur mentioned as the place which Preity Zinta comes to restore her Bebe’s ashes, I was thrilled!). The berth on which I perched for the night had nails jutting out, 2 small kids were sharing the berth opposite mine and I was unable to go to sleep for a long time worried that the kids would kick eachother and tumble down from the upper berth. The father and mother slept blissfully on the middle and lower berths respectively. And the girl was coughing so badly.

From Kiratpur, we hired a van to take us to Manlai. The uphill trudge made some of us queasy, some of us threw up on the way- all in all it was one idyllic journey. The van had to stop at some place for some minor repairs as we got cooked inside. The heat outside made us wonder if we were really on the right route to the snowy caps of Manali. However to our relief and respite the air finally became cooler and the scenic beauty was quite captivating.

We found our hotel- a nice, cosy place but yes it was brrr-cold. Darjeeling on our previous trip was much colder. Here, there were times when I could bear to remove my sweaters and scarves, but in Darjeeling I was clinging to my cardigans, mittens and socks for sheer survival. Our friends who could not live without their daily dose of ‘thayir saadam’ succeeded in finding a restaurant that served good south Indian fare in the hills of Manali. It was a good place though.

Next morning, we climbed the hills to snow point in a place called Marih- Rohtang pass had been closed due to heavy snow fall. Our friends were gasping at the breath taking view of snow laden mountains. I too tried to share their thrill but honestly I was unable to feel the same way. The uphill ride was too precarious but I was too preoccupied with the cold to be nervous. We were wearing all the protective gear and I was grateful for the warmth that it gave. We looked like astronauts. We reached the summit after hours of slow travel. We climbed the snow laden mountains and it was drizzling sleet. The huge masses of frozen mountains that stood menacingly all around awed me naught. To me it looked like an endless expanse of lifelessness- the magnificence failed to evoke in me an inspiring awe. I could only perceive the stillness, the frozen aspect of Nature as lifeless-The gurgling, gushing angry waters of the Beas instilled fear in me- It was always only stretches of lush greenery, flowers and gentle warmth that brought cheer and serenity to my soul. I was wondering why I was feeling different from the others?

When I had seen pictures of snow in the past my brain had understood snow to be soft and spongy. The snow I beheld now were chunks of glassy ice. I was not charmed by the sheaths of glassy, crystalline all around me. My limbs cringed at the assault and I longed for the cosy warmth of the plains. The sheer lifelessness, the enormity of the deathlike glassy reflected glacier sheaths failed to evoke cheer in me. But I looked around me- my friends were laughing and I joined in the merriment. I did not want to be the odd one out. We took photographs – frozen memories. We partook of hot steaming noodles under a leaky tent. It was delicious. And finally we returned downhill.

In the evening we visited the Hidimba ( Bheema’s wife) temple, Vasishtha temple with hot springs. My elder son hung on a harness above the roaring rapids and I looked away.
Next day we trudged uphill endlessly to reach the only temple dedicated to Manu the first Man according to the Hindu scriptures. We also visited the Jataka temple and Van Vihar and did a bit of hurried shopping- mainly for souveneirs.

From Manali we left for Amritsar. The 12-13 hour van ride was tedious to say the least. We wanted to make it to the Wagah border. As we sprinted along the somewhat regulated crowd, I felt excitement building up within me as we moved among people from all over the country. As we passed through that narrow strip of land between the 2 massive gates- Pakistan on my right and India on my left, tears sprung to my eye and I was shivering in the blazing summer evening. I’m not sure I’ll be able to decribe what I felt during those moments, simply because I myself don’t know clearly. Basically I believe in the Universality of Humanity and I feel we are one with Nature and yet during those moments I was overwhelmed by some other emotion that I cannot define or name. Let me just say that during those moments the sheer proximity of these 2 countries which used to be one blurred the margins for me.
We waited on the open balcony seats for the ritual salute to begin. The sun lashed on us mercilessly and the wait was extremely uncomfortable. Patriotic songs blared from either frontiers. At some point, people, mostly girls began dancing enthusiastically on our side of the wall. There were people decrying the dancing display and there were people who simply watched. I belonged to the latter group – unknown strangers from all over the country holding hands and matching steps for those few minutes.
Finally the ritual salute began, the synchronization on either frontier- the salutes, that split second when the flags touched in an embrace, when the soldiers from either side shook hands- those moments made it all worth while for me. I cannot say what went on in the minds of the rest of the multitude. We came away exhausted but with a lightness in our being.

From the Wagah Border we went to the guest house we were to put up for the night. We freshened up and then proceeded to the Golden temple.
My first glimpse of the Golden Temple glimmering in the dark- the shimmering reflection in the waters around as I descended the stairs -it was so astounding . For me, in that moment the whole world reduced to a bubble and I was enveloped by as sense of immensely soothing serenity and sense of well being. For me it went beyond religion or community. I was lulled into a sense of being alone with the Universe in spite of the sea of people around me.
The Gurudwara is extremely well maintained and the members of the Sikh Community irrespective of their socio- economic standing worked towards the upkeep of the entire place. A member explained to us the history of the Gurudwara , at our request. The experience there made my entire trip most worth while and a most cherishable memory. I came away feeling blessed.

We returned to Delhi the next day. We visited the ISKCON temple, the Lotus (Bahai) Temple. As we were leaving the Lotus temple, we received the +2 results of our children. There were three (including my elder son) of them who had appeared for the +2 exams. Excepting for one of the girls, the results were not much to be rave about and that kind of dampened the cheer during the rest of the trip. Qutb Minar, Indira Gandhi, Rajiv Gandhi Memorial were all skimmed through in a blur of phone calls.We traveled by the Metro which was a memorable experience. Finally we returned to our lodgings exhausted and vaguely depressed.

On 10 May, we boarded the train back home. I love coming back home….