Mother

Little had I imagined that 26^th May 2019 would be the one last time I would touch my mother’s feet…

A short, plump and a petite lady, always trimly dressed in a neatly ironed saree and jacket with a pigtail length of hair tightly braided into a bun, she was a person with very strong beliefs on what was right and what was wrong. And once she created a perception in her mind about a person or a place it was permanently etched in her mind like indelible ink. In no way could anyone dislodge that opinion, however logical the counter arguments.

Being strong willed is ‘Great’, but if it borders around being fixated or opinionated it can spell trouble in some form or other. Many a time, I have found myself to be on the wrong side of her arguments and found it safer to concede defeat. But since a whiff of her argumentative nature found its traces into our (siblings) genes, we could also be termed as one-track minded. How we wished at times, the Almighty had inserted a timer in our brain cells and linked that to a particular age when the brain would cease to argue…everything would have been so very peaceful!! The journey called ‘Life’ wouldn’t have had any rough edges. Probably these are just a figment of my imagination. I am pretty sure that there exists no family on earth where no arguments occur. And as Deepak Ramola says in his YouTube video “Kashi Labh Mukti Bhavan” - that it is okay to have conflicts with those around you, but both must agree to resolve all issues before the end of the day. Else, the burden of carrying it though-out one’s lifetime can be a very heavy price that both have to pay. (https://www.youtube.com/watch?v=QwVe7WsZXyU)

Married at a tender age of 13 and having lived a life outside of her home state Karnataka in Durgapur, West Bengal with my father for 38 years, before he passed away with one year for his retirement, a lot of his traits may have rubbed onto her. It was more a husband’s influence in upbringing rather than parental influence during adolescence in my mother’s case.

Being trim at all times in well ironed clothes is something we were used to seeing in our father. Each morning as he set out for his office, he would make it doubly sure that his shirt and trouser were spotlessly clean and well ironed. This was something that my mom took it on herself to ensure that not a single day passed when dad would be unhappy with his outfit. He would shine his shoes each day as a routine and once in a while he would outsource the job to me. I vividly remember him telling me on one occasion that he had a special meeting with his boss and that I must give his shoes an extra shine. I made a great effort to seek his appreciation, but alas – the older generation didn’t believe in handing out rewards or words of appreciation. Later, when I got a chance to ask my mother what that special meeting was all about, she said he was attending an interview for an elevation to the next higher position. I now don’t recall if he got through that interview, but wanted to believe that if he did get that promotion it would be because of the extra shine I had given his shoes. How selfish of me…

Having lived a life with many kinds of conveniences a typical Steel Township can offer for the major portion of her life, the shock of loosing her husband when he was just 57 must have been just too much to stomach. At that time around, I was just making a beginning in my career and had also just got married a year and a week before my father’s departure.

Living In Kolkata (Calcutta, those days) for a Steel township person can be challenging. Wide open spaces, trees lining the broad well maintained roads, electricity round the clock and an assured supply of water when one opened the tap was generally an accepted fact and thereby taken for granted. Kolkata and its muggy weather for a good 9 months in a year with narrow streets, pavement dwellers, the sea of humanity and virtual absence of greenery can be unnerving, especially with the long power cuts, coined “Load Shedding” in Bengal. To add to her woes, we lived in a one-bedroom apartment and I am pretty sure that would have complicated matters further and made her feel miserable and claustrophobic. To her credit, she took it in her stride and slowly started accepting the new normal. It must have reminded her of her initial days when my father commenced his career as a junior engineer. Lucky for her, she had an option of spending time amongst her siblings and daughters settled in Bangalore when I was at Kolkata. She spent almost the entire summer time away from Kolkata’s muggy weather, in Bangalore. She would be back during the splendid festival season starting with Vishwakarma puja on 17^th September (the only Hindu festival which follows the Gregorian Calendar) and ending with Saraswati puja and Holi in March.

Being away at Kolkata had its disadvantages for her as she was far away from her siblings and daughters who were all settled in and around Bangalore. Those days the telecom revolution was just taking some baby steps and speaking to anyone over telephone meant standing in a long ‘Q’ in front of a PCO (Public Call Office), post 10 PM and wait for a chance to get connected when the STD rates would be slashed to one-quarter of its regular call charges till 6 AM. Most PCO’s had kept the Timer/Call Cost display prominently for people to keep a very close tab on the length of their dialogue. This innovative way of display became a necessity when people looked at disbelief when the telephone churned out a bill at the end of the call. There would be heated arguments between the PCO owner/manager and the person making the call. Each person making a call would never agree on their call duration. They always felt that the timer logged extra time and squarely blamed the PCO owner/manager for having tinkered with it, and make the timer log 1 min in just 45 seconds. I guess the prevailing disbelief on our EVM’s (Electronic Voting Machines) had its beginnings with these STD/ISD PCO booths. With each additional minute the heart would pound faster, because as Indians we do not know brevity and how to cut short on our bye-byes…they seem endlessly stretched. Every Indian felt that there was a devil sitting inside these electronic counters/machines, continuously manipulating and speeding up the meter. The fears are so deep rooted that even today, as a passenger if you are using an autoriksha or a taxi service, your eyes are glued to the meter for the entire duration of the journey, petrified at the rapidly whirring Rupee count. Hence, my mother preferred to pay the Indian Railways and travel twice a year to Bangalore for a face-to-face dialogue instead of paying for the Indian Telecom Services.

When we as a family did migrate back to Karnataka from Bengal in the year 1992, she was mighty pleased. But having built a strong bond with her near and dear ones during our stay in Bengal, she continued to spend long lengths of time with them, happy amidst them and enjoying their hospitality and camaraderie.  

Besides education, the best that parents can give their children is to lead by example in being truthful, honest and accommodative. Anything more than these are certainly welcome, but should be considered a bonus from parents. My dad was a self-help specialist – a handyman at home and through him I learnt the basics of electrical wiring including switchboard repair or replacement, Carpentry, Plumbing and Masonry work. Most of the learning happened by watching and being his helper and the only item that he had accumulated over his lifetime, is my prized possession to this day – his wide array of tools in a toolbox. Over the years I have also been able to add to the box and also passed on this skill to my sons, who have themselves added more ‘Special’ tools. We are immensely proud of this inherited legacy!

My mother used her tailoring machine extensively. I remember her telling us proudly that Dad had bought this for her in installments – it cost him Rs 240 at that point of time in history! Having daughters at home, a tailoring machine I guess was a necessity those days. Concept of ready-made dresses wasn’t there and even if it was, dresses were way too expensive and unaffordable. Option was to stitch at home and save costs. What this meant for me was - machine break down. I became her handy-boy, to make it operational again. My school classes used to get over at 12 noon and the only time available for mom to stitch were the afternoon hours. Invariably, I would watch her measure, cut and stitch each time she set out to make a new dress for my sisters. Observing her made me to try my hand at doing some odd jobs and help her. Eventually, I became pretty deft at the job of cutting and stitching myself. During my engineering college days and on a visit o Bangalore, I remember having stitched a pretty frock for my niece on my aunts hand operated Singer machine.

Measuring, cutting and stitching is like learning and practicing geometry – it’s an exact science! Also, one gets adept at visualizing how the finished product would appear or, how one would like it to appear before even holding your pair of scissors and making the first cut.

My mother had an Usha (Foot Peddle) machine which I exchanged for a compact motorized “WonderStitch” from Usha-Janome a few years back. This machine makes stitching an easy task and also has many stitch patterns/variations to experiment with. My mother’s prized possession was a stitching toolkit which had virtually every possible item required for cutting, mending, threading and stitching. This toolkit was handed to me, the day she decided that she could stitch no more and to this day it has remained my prized possession and in use!

Stitching is an art and certainly brings out creativity in the human mind. To make a beautiful idol, if a sculpture chips away stone, that is not required from a rock or a marble, a tailor cuts unwanted cloth from a piece and then stitches the parts to make it whole again and in both cases the Master – Sculptor or Tailor must be able to visualize the final product even before the tools are picked up. In a way it is a stress buster and also  akin to meditation - it develops a single minded focus on our objective and helps concentrate till the job is completed. A wrong measurement or if incorrectly cut, can ruin the entire cloth and a wrong stitch can result in rework. 100% quality work is an absolute  necessity – nothing less!

How healthy a person is depends on parents genes to a great extent. Our earlier generation certainly are/were better than ours. The unadulterated food available during their early life determined how healthy and fit they would remain throughout their days and years ahead. With many mouths to feed and limited resources, it was in fact a blessing in disguise. There was no question of obesity among the children and with no electronic devices, all activities were physical and this kept everybody fit as a fiddle.

While there may have been an odd premature departure or two (my father being an example) in general our earlier generation has been successful by and large in leading a long life to reach their eighth or ninth decade. My mother too was relatively healthy till she reached 83 years and 6 months i.e. till August 2018. But for her cataract condition and lens replacement, the only other time she was admitted in recent years was when an arterial block was noticed and a stent slipped in position to clear the block. This happened in December 2014. One other nagging problem that forced her to drag her right foot was osteoarthritis on her knee. This caused tremendous pain but she preferred pain killers over a knee replacement surgery. She was clear that she did not want to go under the scalpel.  

More recently in September 2018 when she spent a month at her youngest sister’s home in Periapatna – a tiny town between Mysore and Madikeri, she started losing weight. She complained about diminished appetite, exhaustion and nausea. The doctors who examined her did not notice much and guessed it to be  variant/version of gastritis and provided symptomatic relief. It did not occur to anyone that this probably needed some additional attention. On her return from Periapatna, she stayed at her brother’s house in Mysore for a day/night. Her niece, who is an Oncologist of some repute in Mysore did examine her but she too did not see any reason for additional investigation.

She returned home to my house in Bangalore and recouped to a fairly great extent with the medicines suggested by her niece. Matters got worse, when in the month of December during her brief stay at my sisters house, she was unable to manage to stand without an attendant. Her frequent visits to the bathroom made us think that we must get her examined thoroughly. Not really knowing where to begin we took her to her cardiologist Dr K B Prasad with whom she had been in touch since 2014. After examining her he suggested that we take her to Dr Raghavendra Prakash, a young and smart General Physician. While Dr Prasad may have suspected something serious, he requested us to get her thoroughly examined by a GP and take his advice. Dr Prakash was quick to tell us that we should first get a simple ultrasound scan of her abdomen. Leading my mother to the scanning center was in itself a herculean task and full marks to my eldest sister for taking the responsibility in first taking her for an ultrasound scan and then on the advice of GP taking her for the 2^nd time for an MRI. Dr Prakash had by then guessed the problem and after examining the images confirmed what we did not want to hear. Cancer of the Colon.

The report accompanying the MRI stated that both Lymphoma and Sarcoma existed together. While Dr Raghavendra Prakash also repeated the same, he went on to add that if it were Lymphoma alone, it could have been treated with medication and radiation. But if it is confirmed as sarcoma matters could be complicated. The position also seemed to be a deciding factor. The tumor seemed to have surrounded itself around the aorta to abdomen and it's two branches that goes to the two legs. He said surgery might be ruled out by Dr Srinath after examining her. Dr Raghavendra recommended that we meet Dr Srinath in Sri Shankara Cancer Hospital and Research Center and take his opinion to see what are the possibilities.. Dr Srinath is a Surgical Oncologist and is considered to be the best in this field in Bangalore.

In the meanwhile we had shared all the documents and details with my mother’s niece & Oncologist, Madhavi who endorsed that we must without any delay meet Dr Srinath. She personally knows Dr Srinath and Dr Shekhar Patil from her HCG days and to this day remains in touch as part of Oncologists fraternity.

We were able to get an appointment with Dr Srinath for 24^th December 2018. The hospital has a protocol of an assistant doctor first meeting, examining and taking the entire patients history. When Dr Srinath comes in, the assistant doctor relates all their observation and finding. They then wait for Dr Srinath to first question them for getting the complete picture and later request him to express his understanding of the situation to the patient and accompanying family. An elderly gentleman, Dr Srinath is a man of few measured words. He did a thorough examination of the patient before looking at the scans, MRI and the associated reports. I guess he did not want the reports to cloud his examination and judgement. We waited with baited breath to know his opinion as an expert.

Dr Srinath confirmed that the enlarged and rapidly growing mass had encaged not only the aorta but had attached itself on to the vertebrate column as well. He too suspected Sarcoma. If this is confirmed after biopsy, he said surgery is ruled out completely, because the tumor’s position around the aorta and its spread into other vital and sensitive areas/organs would rupture and this would be fatal.

The next step he said was to admit her in the hospital to do a biopsy using CT guided long needle aspiration technique. This will help determine if it's a lymphoma, sarcoma or GIST (gastrointestinal stromal tumor). If it were to be lymphoma then chemotherapy and radiation in succession would be the immediate option. But if it were sarcoma then only palliative care would be suggested. As an outside chance, if it were GIST, then one tablet daily would help shrink the mass over a length of time.

We took the call to get her admitted the same day for the biopsy and for taking the help of hospitals nursing facility to get her back on her feet. Dr Srinath also cautioned us that her stay in the hospital could be minimum 5 days to a maximum of 10 days. Reason being – stabilizing her health and ensuring all the vitals were normal before conducting the biopsy. However, the nursing staff and the duty doctors were able to quickly bring her to normalcy and did the biopsy on 26^th December 2018 itself. She was wheeled in at 5:08 PM and came out at 5:21 PM.

The surgical team of doctors who came on their rounds on 27^th December 2018 informed that she will have to remain in the hospital till the initial IHC (ImmunoHistoChemistry) report comes within the first 24 to 36 hours. By the time we got the green signal for her discharge, it was 10:30 AM on 31^st December 2018, but 7:15 PM when we finally left the hospital with discharge summary and prescription.

Under normal circumstances 6 markers in IHC provide the complete characteristics of the malignant tumor, but in mothers case an additional 4 were ordered and the final report was handed over to us on 4^th January 2019. The conclusion/impression as written in the report was Diffused Large B Cell Lymphoma, DLBCL in short. This is a treatable malignant tumor through a combination of Chemotherapy and Radiation. When we met Dr Srinath with the report, he infused within us a lot of hope that mother may after all get well… Dr Srinath then asked us to seek an appointment with Dr Shekhar Patil and Dr Ravi Tippeswamy, who would guide us through the next steps.

For my own understanding I checked on the internet for more information on DLBCL: It is a cancer of B-cells. It is a type of white blood cell responsible for producing antibodies and the usual treatment for this type of cancer is Chemotherapy. It is a combination of 5 drugs and is called a cocktail by Medical Oncologists and is administered through IV. The medicines are CPR + DV – rearranged and more familiarly known as R-CHOP.

C = Cyclophosphamide; P = Prednisolone; R = Rituximab

D = Doxorubicin; V = Vincristine

This combination needs to be injected 6 to 8 times at 3 weeks interval between two successive chemo-sessions. At the end of the cycle, a PET scan is done to determine or identify where the residual Tumor is present and then give targeted radiation therapy.

We met Dr Ravi Tippeswamy on 5^th January 2019, but he insisted on examining mother before deciding on what kind of treatment to provide. We had to return on 7^th January to Sri Shankara Cancer Hospital to see Dr Tippeswamy. We were the first to be present at 10 AM. Dr Tippeswamy brought along Dr Shekhar Patil and it was Dr Patil who suggested that we start off on Chemotherapy with CPR (combination of Rituximab, Prednisolone and Cyclophosphamide), considering that she was 83 years old. We got her admitted on the same day and tentatively set 9^th January 2019 for the first chemotherapy. As planned the Chemo-dose was pushed intravenously from 10 AM and was finally completed the following afternoon at 5:00 PM. By the time she was finally cleared to return home it was 8:00 PM. We were told that chemo dose was restricted to CPR keeping in mind her age and also to avoid severe adverse reactions that normally occur when the balance two drugs are given.

We were given a whole lot of prescription drugs for the next two weeks to control a variety of side reactions. While the second chemo-dose was fixed for 30^th January 2019, we were asked to get her blood tested for CBC and RFT on 18^th January, just to be sure that her vital parameters were under control.

We got this done on 18^th January and found all her parameters to be under control. When this report was shown to Dr Ravi Tippeswamy, he said that we should go ahead and book a bed for the 2^nd Chemo on 30^th January 2019.

On 30^th January 2019, we received a call from Sri Shankara Hospital that the bed was ready and we should admit mother by 9 AM. I had made arrangements with a local Ambulance service provider for a drop. Post admission and after a routine blood test, they found her sodium levels at 124 instead of 132. The put her on re-sodium through IV and said if they see the sodium rise to 128, they will simultaneously administer the Chemo – CPR, like last time. We were also forewarned that her adverse reactions may be much higher this time.

Although the Chemo was completed by 5 PM this time, by the time the discharge summary and related documents were handed over to us it was 7 PM. My mother accepted the second chemo dose pretty well and adverse reactions were also muted.

Our next visit was scheduled for 21^st February 2019. As per the hospital instructions I got her blood tested for CBC and LFT on 20^th February 2019 and went to meet Dr Ravi Tippeswamy. I also gave him the complete picture of her poor progress and her being totally bed ridden. I also told him that her body mass had drastically fallen and mother herself was against taking the third dose. Doctor then decided that we must stop further chemotherapy. Moreover, the desired result after two doses were not visible too. There was no improvement in her quality of life. She could do nothing on her own. But he did mention that she was likely to suffer for 6 months or beyond.

On hindsight we human beings are always wiser. The question we started asking ourselves was…whether making her go through the chemotherapy twice was the right decision. We reconciled to the fact that with information available at that point in time i.e. on 24^th December 2018, it was a wise thing to go ahead with the chemo since doctors had given a hope that her quality of life would improve. Two months later, with more data points in front of us, was there a point in questioning our earlier decision? I guess not…it wouldn’t be fair to ourselves. But, we ended up giving hopes to my mother and her near and dear ones that she may after all become near normal in the next two months. Alas, this did not turn out the way we wished.

Having now taken the decision on 21^st February 2019 to stop further chemotherapy the question on top of our minds was, what next? Dr Ravi Tippeswamy said that we have to make her as comfortable as possible and give her symptomatic medication. Address each and every problem as it unfolds…So for the next three months we kept a very close monitor on her conditions and each day the medicines and dosage underwent changes depending on what her problem was.

We celebrated her birthday on 16^th March 2019 in the best possible manner. All her children and a few of her grandchildren were around her singing to her the “Happy Birthday” song. She took the opportunity to distribute all her prized possessions and belongings on this day amongst her children and grandchildren. It was a very touching moment for all of us when she said in broken sentences, as she had become a bit disoriented and incoherent by then, that other people of her age would have gifted land and property and she was only able to share her possessions that dad had provided to her during his lifetime and the savings that she had accumulated over the last 33 years post his departure. My wife had organized a simple lunch for all and after brief bye-byes everybody left with a heavy heart and tears in their eyes not knowing when and how the end would come.

My mother did brave it out for the next two months with each day offering a different kind of challenge and ailment. The strong willed person that she was, always ready to put up a brave fight, it was painful for us to see her lying helpless for so many months on her bed and requiring nursing support for virtually everything. Towards the end she used to be in a trance when awake. To make it easier for her, we were compelled to give her drugs that would ease her pain.

My wife would retire post-midnight hours every night and would peep into her room for one last time to check if all was well. Hearing her snores at regular intervals was a fair indication that she had successfully crossed yet another day. My schedule was to get up by 4 or 4:30 AM and walk into her room to see if everything was normal.

On 26^th May 2019 also, when I woke up at 4:30 AM and walked into her room, it was reassuring to hear her snores at regular intervals, but it appeared to me a tad faster than the usual pace. But since she was fast asleep, I guessed it would be a normal start for yet another day and went about doing some odd household chores like preparing coffee decoction, heating the milk and placing the washed dishes in its respective slots. Kitchen in our house is adjacent to my mother’s room and her snores can be clearly heard. Finding everything normal, I stepped out at 6:15 AM to sweep the portico from the dry leaves and dust that comes each night with wind. My wife came down at 6:25 AM and went straight to mother’s room to check if all was well. Not hearing her snores she tried giving her a light tap to see her response. Just a light touch would make her scream out with pain but today there was no reaction. She called me in and asked me also to check. It was 6:30 AM by the time both of us along with her nurse checked for her vitals like pulse, heart beat and BP. There was no response and she wasn’t breathing. Her face was calm and in a flash of a moment she had departed peacefully, leaving us all behind. A victory for her indeed!

It was the one last time that my wife and I got an opportunity to touch her feet and seek her blessings!! May her soul rest in eternal peace!!