You could hear Mendelssohn’s wedding march from the end of the corridor. The music was loud and clear, rising above the usual buzz of every day life (and death) on the ward. The prognosis was only “a couple of days” or rather “ a couple for days”. But this did not stop this 44-year-old lady from organising her wedding with the help of her friends and family. TN walked into the hospital with ascites; an unusually large collection of fluid in her abdomen. Though ascities can be the sign of many diseases, TN had a more sinister process spreading in her body without control. Her ovarian cancer could not be held back by chemo or other treatments. The only option was to keep her as comfortable as possible and be as honest as one can be when breaking bad news.

Telling someone that they will not be around to see the next Christmas or hold their first grandchild is never easy. Asking someone to accept that modern medicine has nothing more to offer and that there is not even enough time to seek a second opinion is a hard task. But I found all these years that there is often a single source of energy that makes this responsibility, easier to tackle and softer to tolerate; the dying patients themselves. TN told me bravely “it’s fine”. She held my hand, released a sigh of closure and allowed a scanty trickle of tears to wet her pale cheeks for a few seconds. Every salty drop was washing away some more of her colour. She whispered that she believed in love and that she was determined to march down the aisle and become a wife, even for a few days, even for a few hours.

Two days later, everything was ready. The hospital room was decorated by the nurses and the guests arrived bearing the rings and a chocolate cake. The banting was white and red and formed a ceremonial arch above the hospital bed. TN was dressed in her white hospital gown. The minister delivered the words and the vows echoed the room. She walked down the illusionary aisle supporting herself onto everyone’s imagination. But she didn’t stop. She looked back and smiled. She refused to fly out of her white gown and continued to march on until she disappeared into the light 3 days later. Mendelssohn was still playing at the background.

 

MV was one of the most enthusiastic people I have ever met. It is not often that you come across people who are oozing with life and their presence and positive energy reverberate effervescently in an otherwise dull and unremarkable space. I feel fortunate to have come across two such people in my life thus far. Though struck by misfortune from a very young age, she always found ways of standing back up and facing whatever might be thrown at her. Ironically, towards the end, standing up became a mechanical issue rather than a motivational one. She had a fall and fractured her hip. MV slowly slipped into depression and died a few months later from a stroke.

It was believed that when the Gods were upset with someone they would often strike him/her down; the stroke of God’s Hand. Whether that was with a thunderbolt, or a barrage of misfortunes, a stroke was believed to be the calculated aftermath of aggravated fury at a divine level .

There are two major types of stroke. The commonest one is called ischaemic stroke. It is usually caused by a clot or a collection of cell debris, blocking off the blood supply in a territory of the brain. That part of the brain is starved of blood (and oxygen) and will eventually stop working. If the patient survives the stroke, then in the following few months the brain will try to remodel the remaining nerve endings in an attempt to recover lost function. It is very rarely that we see a dramatic recovery from a major stroke (large area of the brain being affected). The other type of stroke is called haemorrhagic and occurs classically when a blood vessel breaks down and bleeding inside the brain ensues.

The power of the brain is demonstrated on so many levels; whether it controls the way we move and speak to how we perceive emotions and process memories. In a remarkable array of nerve connections, the brain can transform pulses of electricity into experiences and vice versa.

When MV was feeling depressed, she was not simply sad or marasmic. She was in a state of uninspired existence. When she wasn’t eating, her body was telling us that she wasn’t interested in any nourishment. When she wasn’t sleeping, her mind was telling us that there wasn’t any reason to dream. And when she only spoke sparsely, her mouth was conveying a far bigger message than the weight of her words. Eventually, when she was “struck” we all understood. When her body ceased to move and her spirit stopped being, the answer became clear. She had left
the lights on but left the home months ago…

M

It is often the case that your imagination will take you in a place where you just want to be by yourself. A place in your mind where you just exist in unison with your own thoughts. When you feel that the moment of when you completely understand yourself has arrived. It is also the case that often you may not find that place and you may not savour that moment. When you blink and you are still there… Then you look for other ways to make peace with the scars that your emotions may have left behind. You finally unleash your creative instincts and when you are ready, you invite the rest of the world to your circus.

This is my blog and this is my circus

Since I can remember, music has been my compass, regardless of wanting to travel to or away from home. I always looked for inspiration at the most unusual of places and most enigmatic of concepts. Nothing, however, moves me more that the human truth. The truth of the human story that unfolds between the extremes of life and death, and tells the tale between just two emotions; happiness and sorrow. And I have been part of countless such stories, looked at life in the eyes and told the coming of death.

I am not here to say the story of other people, I am not here to say my story either. I am a physician and a musician, and I write music inspired by the human nature. I want to share my own truth as I see it trough my patients, whether their journey takes them across the threshold of the ending or over the clouds of hope.

M