My journal of death

Students praying at a school in Thimphu, Bhutan, in 2014. A 2015 piece in the BBC by writer Eric Weiner, discussed how contemplating death five times a day is part of the Bhutans culture, and why this might be linked to the countrys high happiness index.

AN ideal death," says Dr Kashyap Patel at the end of a 45-minute conversation, over the phone from South Carolina, "is when one is surrounded by family, nobody is crying that you haven-t had a full life, you have done everything you could do and have no regrets. You have lived life to the fullest… My father-s death was exactly like that."

Dr Patel is an Indian born oncologist, who practiced at Mumbai-s KEM Hospital in the early -90s - interestingly, as he juggled a journalism career with the Indian Express in the evenings - moving on to the UK and then the US. Currently, he is the vice president for the Community Oncology Alliance, chairman of Clinical Affairs for the Association of Community Cancer Centers, and he runs the Carolina Blood and Cancer Care Associates.

Speaking of his father, who lived in Ahmedabad, Dr Patel says, one day at 4 pm, he asked his grandson, Dr Patel-s nephew, to fetch him a glass of water. "He put his hand on my nephew-s shoulder and said -this has been a pleasure. Let me go to sleep now-. And he left his body in his sleep."

It-s an odd year to talk about death. We are in the middle of a pandemic that has already claimed nearly 7.5 lakh lives worldwide. And, yet, in so many ways, death is inevitable for all. Quoting the Bhagavad Gita, Dr Patel, says, "for those who are deceased, birth is certain and for those who are born, death is certain."

Why would, however, an oncologist write a book about dying? The 59-year-old who has "dealt with death daily" admits that there are several stories of miraculous cures even. "However, I know that one out of every three patients that walks into my clinic will not make it beyond one or three years. And, we have to prepare those who are leaving the world for that journey. We celebrate baby showers, birthdays, but not the inevitability of death. Every day I live is one day off my schedule. It is certain that I will die and I don-t think death is the end of my existence," he says. His book, Between Life And Death Penguin Random House India, is a series of conversations between him and a patient, Harry Falls - all patient names have been changed to protect the privacy of their families - as they discuss death, its meaning, how different religions approach it and why accepting it might be liberating.

We discuss a 2015 travel article by BBC writer Eric Weiner, in which he mentions that "Bhutan-s Dark Secret to Happiness" is the regular contemplation of death. Can discussing death - one-s or a loved one-s - help, especially if it is imminent? Yes, advices Dr Patel. It will help us process the grief better. If a loved one is ailing, give them permission to go, he says. There-s always the feeling that one could have done more to help the ailing friend, parent, relative. But, having the conversation most of us avoid, will lead to more acceptance and less guilt. It will ease the pain of those left behind.

Dr Patel understands that breaking the news to a patient, who has come for a diagnosis, can be difficult. Not only for the patients, but also the doctors. He now regularly conducts retreats for other medical professionals in having a better, more open communication about dying. He also makes regular home visits to his patients.

Dr Kashyap Patel

On the death of a patient, he speaks of 90-year-old Lily, who called him her -boyfriend- in jest. One day, when he was on his way to attend a wedding, Lilly-s son called him saying she had gone into coma and was whispering his name. Could he come to her side? Dr Patel changed his plans. With him next to her, she woke up and said that while her family was with her, she couldn-t leave without bidding him goodbye. And, she passed.

After a day such as this, Dr Patel says he returns home and goes deep into meditation. "I do yoga, go into a trance and tell my wife not to talk to me as I have to get over this. I breathe out all the grief," he adds. When he was 16 years old, Dr Patel-s father bought him a book, The Yoga Sutras of Patanjali by Swami Vivekananda. He has 10 copies of those lying around in his office, living room, bedroom. "And, I go through the book regularly."

Like Falls - whom he chose to centre the book on because he served as a pilot in the Royal Air Force and so had had moments when one might feel close to death, and knew about cancer because his wife Susan, is an oncologist - Patel too continues to prepare for his own death. Not just is it a conversation he has, but he says, he spends 10 minutes every day witnessing his life. "If I have offended anyone, I ask for forgiveness in my mind. If someone has offended me, I forgive them. This is a closing of accounts of sorts. If I pass away in my sleep, I would not be carrying over regrets."

Falls also represents the ideal for a terminally ill patient. Having been diagnosed with extensive-stage small-cell lung cancer, Falls could have opted for treatment that may have prolonged his life by a few months. But, instead of living on tubes and in a hospital, he chose to spend the remaining period with his family, at home. His only request to Dr Patel was that his wife and daughter not be around when he breathed his last. "But I told him that was something I couldn-t guarantee. He said -we will see-."

"I saw him at 5 pm and went home. He died that midnight. When I spoke to his wife, Susan, she said the cats ran out of the house at midnight on seeing someone outside the door and we followed them. That-s when he took his last breath. Till the last minute, Harry was in control of his body."

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