The Last Leaf

Its like that story by O' Henry where a young girl has severe pneumonia in a bitter winter and somehow comes to believe that once the last leaf of the fast withering small sapling drops she would die too...And a failed artist creates a miniature leaf on the stem of the plant in the ice cold winter night when the last leaf does fall down. And the girl hoping to see the bare stem in the morning cannot believe her eyes when she sees the same leaf still standing on the stem after the harsh winter storm...It gives her a new lease of life, she lives through her illness and comes out of it.

Do brain dead people see? Do they hear, feel and react? Do they feel the necessity of leaving their loved ones once they realize the love that they initially held for their own has been put to test by the endless chores their resilient unmoving body heaves on the hapless attendants, sons, daughters, brothers? The humdrum of suctioning, of bedsores, of cleaning grime in thigh creases of overweight bodies, of tracheostomy wounds, of periodically deflating and inflating the cuffs, of putting 'body' in left lateral, feeding in sitting, reclining with head end elevation, putting Ryle's tube in flexed head position...and so on... ?Do they also like to metamorphose and leave their present decaying bodies for a better, more ethereal, more eternal continuum that spares their attendants that inaudible sigh of relief they exhale when this person, with an IC Bleed, Left Internal Capsule, with extension into the lateral ventricles and an associated midline shift of 1.5 cm to the right, finally decides to give up the breaths she has been struggling to take.

It surprises me, then to see how the story actually unfolds; from the first day, when the attendants are, by turns, demanding, threatening, cajoling, waiting for that once hair raise from the doctor, when they are prepared to do 'anything', absolutely anything for their patient...they spread the sheets, they complain about leaking iv lines, about dead iv fluid bottles and about suctioning not being done well enough....and ithey are willing too, to get the ABG reports at 2 : 40 in the morning, and show it to the sleep infested doctor on duty...

Equations change...with time, the zeal to do 'anything, absolutely anything' is tested by roughly 5 visits to the pharmacy, 15 visits to the emergency lab, position change, suctioning ( an act, the responsibility of which which by now the doctor has relinquished on the attendants), and not to mention that occasional outburst from their screwed up doctor, who in an attempt to overshadow her own irate temperament at seeing that unmoving body day after day without any progress, or deterioration, and having told their attendants roughly 900 times she wont make it, decides to unleash her anger in more unscrupulous ways....She gives them a BGA at 3 20 in the morning, asking them to collect the report and show it to her in the morning..and watches the attendant bundle past her with shuffling steps on a bitter cold emergency night at Rohtak, a small, dimensionless city in North India....

She (the doctor) changes as well, the lady was a grossly obese 36 year old with 3 kids and a out of job husband...the attendants are, in order of their willingness and love for the patient, respectively the Brother, the Son, and the Bahu. She takes a look at the pallid skin, the toneless chapeless heap into which the body has been confined, the rhythmic swell of her breasts through which the heart sounds seem so faint she confuses if the heart is beating at all....the bed sore on her left butt, that unhealing patch of yellow, red and pink that still doesnt give her fever but that which has festered all this time...She asks about how much they have spent till date on her, and the Son gives a rough estimation: 25,000....with tears in his eyes...

25,000...thats a small number. Going by Haryana's standards, it may even be called negligible, a quick mental mathematics suggests her it could not be so much, with 2 CT Scans and some medications....but there is still a possibility...Her stance softens...She gradually introduces the topic of the famous DOR...Discharge On Request, partly with a guilt ridden heart...She backtracks in the middle...Her ethics don't support her...She once again gives the example of Life support systems and its use in America...She assures the they can, and then, they must take more time to decide....she would tell the medications...the rest in the line of care she would tell them....The guilt pang hits home again...she asks them to stay for 2-3 days more...and walks back to the resident room.

Thirty minutes later, the Brother, the decision maker comes to her...they would leave the next day, he says...she is shaken..'No, no, I don't want you guys to leave, I was only telling this because you guys told me just how difficult it had become to feed your hungry mouths...stay here for as long as you want..' , and then with new found insolence in the voice, talk to my seniors, they will tell you....

40 odd minutes, that dead body, listening to their conversation decides to die...She performs an average CPR, takes an ECG out of a machine that only traces flat lines, and declares her dead...None of the relatives make a sound, they are complying almost, they listen silently to her condolence of how her period of torture was fortunately cut short, they ask to keep the body in the hospital for the night, and they move with lightning efficiency to clear the bed and do the necessary.

The only tears are hastily shed by the son, who then moves on too, and a transport certificate ends that 10 day relationship she and her family had come to establish as the IC Bleed patient that was 'still alive'...