Reflecting on "HIDDEN BRAIN" The Ventilator: Life, Death And The Choices We Make At The End

This week’s podcast of Hidden Brain really hit home for me. The episode raises intriguing questions about end-of-life decision. Shankar Vedantam's narrative takes us  through the question "The choice was always, do you want to see tomorrow?"

The episode takes us through the journey of a family grappled with the same question. Over the decades, they talk deeply about the choices they would want to make in the face of an incurable illness or terrible injury. But when the time came to act on their beliefs, they discovered a question they hadn't considered. What if the seemingly rational choices you prefer when you're healthy no longer make sense to you when you're actually confronting death?



The questions around life, living and the reluctance to embrace the inevitable death even when it is staring you in the face are topics that I have been reflecting on since my father was paralyzed and eventually spent the last 8 months of life needing 24 X 7 care and support just to see another day; a day that may not be better than the one gone by.

I also began to appreciate how rational people react when facing the inevitable end. My dad was a proud and active veteran who had spent his early retirement years traveling around with my mother. He continued to be upbeat, even when facing the of debilitating effects of Parkinson’s.

What will happen to me after I die?

Would we be better prepared to embrace death when it inevitably comes calling, if we can answer this question? It is a question that humans and philosophers across civilizations and generations have pondered. Religion, spirituality or even the study of history and anthropology doesn’t give a clue into death and what lies at the other end. And if there is something in that ‘black hole.’

Humans don’t have the answer since the dead cant tell us what’s on the ‘other side’. And while the living can be certain that death isn’t reversible, we don’t have an assurance that the unknown we pass onto is going to be any better. Hence we take comfort in the status quo, and the certainty of life as we continue to live.
Of course, not all of us are destined to face this question. For many, death may be sudden, abrupt or untimely; leaving only the survivors to come to terms with death.

I have often wondered about the reason why people like my dad, and the protagonist of this podcast, Ms Stephanie Rinka want to struggle to live.

It is the will to struggle through the ailments and live to see another day, or is it the fear of the unknown finality of death that keeps them hanging by a thread?

30-60 Children die at Gorakhpur Hospital: Musing on the heartlessness of business, administration and politics

Reading about the shocking incident at a hospital in the Indian city of Gorkhpur sent a shiver down my spine. Parents of the kids with various ailments who were admitted at Gorakhpur’s Baba Raghav Das Medical College Hospital allege that oxygen supply for the patients was turned off as the vendors’ bills for the supplies had not been paid by the state government.

Initial media accounts published notifications received from vendors - Pushpa Sales Pvt Limited, the company which supplies liquid oxygen to the Hospital. According to letters from the vendor, Pushpa sales had decided to stop supply of oxygen cylinders to the hospital since its bills hadn’t beenpaid for past supplies (link):  

# “The delay in payment is reaching six months… in case of further delay, the entire responsibility would be of BRD Medical.”
# “We would be unable to continue supply… in case of non-payment of dues… it would not be our responsibility.”

Pushpa’s managers probably approached this as yet another business transaction: A vendor threatening to or actually stopping supplies when past bills are overdue is a common business practice. It is shocking to imagine how the managers didn’t stop to think that the supply of the ‘goods,’ (oxygen cylinders) would literally lead to life-and-death consequences.

The incident has generated a huge political storm with the media and digerati weighing in. While parents allege lack of oxygen supply as the root cause, the hospital administration is taking cover under obscure medical records by stating ‘each case of death is unique and different.’ (link)

Having lived and worked in a dozen countries around the globe, I can understand - but still not empathize – with the constraints under which middle-managers operate. Unpaid bills of over 40 lakh rupees -nearly US$80,000 as the media reports indicate - is not a small amount by Indian standards. One can guess how a middle-manager at Pushpa Sales might have been under tremendous pressure to have the bills cleared. Perhaps his job was at stake too, and he decided to stop supplies to ‘threaten’ the hospital administration as a last resort.

Similarly, hospital administrators are also business managers accountable for Profit and Loss and general operations and surely must have tried to ‘resolve’ the impasse. In all this, did they stop for a minute to think: the ‘goods and supplies’ in question are oxygen cylinders destined for a children’s ward were helpless, innocent children might actually DIE if they didn’t receive the intake of oxygen? Post mortems and review of records will eventually unearth the truth, but by then the attention of the media and digirati would have moved on. The hapless parents will be left behind trying to reconcile the loss, eventually attempt to come to grips with it.

As a father who lost a child years ago, my heart goes out to the grieving parents. No parent should have to go through the tragedy of burying a child. It is just not right.  

Ref: Aditya Mohan

Human lives are too precious to be squandered because of corporate greed and ineptitude of hospital administrators.