Angels at the Time of Death

“I understand I’m dying, and I’m not scared of death, but I don’t want to die right now, this was not according to plan, I’m not prepared, not yet.”

These were the words of a man who understood the nature and the progression of his illness, but was clearly not prepared for what was to come. Mortality is inevitable, but it is almost always disagreeable.

Arif was 60 when he was diagnosed with prostate cancer in 2020. A loving husband, a father to a son and a daughter, little did the family know that the next three years were going to be the toughest years of their lives. From multiple visits to hospitals, to several tiring sessions of chemotherapy and radiation, from hope of being cured, to the despair of reality, those three years, as his son would tell us later, were dark and long.

The cancer eventually spread to his spine and to the other organs in his abdomen. All curative treatment had served its purpose, and the doctors advised palliative care as his only option which was when he was referred to PALCARE.

It was a typical warm Mumbai October morning when our team of doctor, nurse and counsellor visited Arif’s home, an apartment in Mira Road. His son, in his late twenties, was at the door and welcomed us. He was soft spoken, and as we sat in the living room, I immediately noticed the pain and tiredness in his eyes, something his lovely smile could not conceal. After the initial introduction of the PALCARE team and our service, and after taking the family and Arif’s medical history, we proceeded into the bedroom to see him.

Arif was lying down on a hospital bed, he looked weary and distressed, but he had a lovely smile, quite similar to his son’s. We spent the next hour or so discussing his symptoms. He was troubled with intense vomiting, excruciating pain – physical, emotional, and spiritual. We knew there was a lot of work to be done.

As the team doctor and nurse were discussing the care plan with the son, I, as the counsellor, took the opportunity to talk to Arif. He did not take much time to open up. It felt like he was waiting for this moment for a long time. He opened his heart and spoke about his life, work, children and about his fear of leaving his family behind. He expressed concern about how he would not be able to fulfil his responsibilities as a father. He spoke about his suffering and pain, about hopes of feeling better knowing well that the cancer was killing him, slowly but surely. He spoke about the fear he saw in his wife and children’s eyes. He expressed how he was not prepared for this. All I did was listen, all I could do was listen, and somewhere I felt all he wanted was for me to listen.

We told him that we could not cure him, but we promised to bring his symptoms under control, we promised that PALCARE was there for him and his family till the very end and beyond, and we did just that.

The family was very supportive and followed our care plan, and his pain was brought under substantial control, as were his other distressing symptoms. Like all our other patients, we worked very closely with the family. The team visited the family frequently. We were in touch through phone and video calls. Regular counselling sessions were done with the patient and with members of the family. The care plan was modified every time a new symptom came up. There were good days and there were not so good days, and through it all PALCARE was there with them. The son told us on one of our visits that his father would wait for our team to come see him, and every time we visited, he had a smile on his face.

As the days went by, Arif’s disease progressed, and his health further deteriorated. I remember our last visit during which he stopped talking, was not all there, held my hand tightly, and smiled the same smile he had worn the first day.

On the 18th of November 2023, Arif breathed his last. His death was painless and peaceful. He was at home, with his family, and during his last moments, our team doctor was on the phone with the son.

On the bereavement visit, the son told us with teary eyes, that in the darkest moments of their lives, PALCARE came as a ray of light, he said he could not thank us enough for our support and care.

There are times when I think of the work we are doing, and if it is worth doing it as after all palliative care professionals are often known as ‘angels of death’. But then through working everyday with patients and families such as Arif’s, I know that it is worthwhile, and that instead of being known as angels of death, we should rather be known as angels during the time of death.

*Name has been changed for the purpose of confidentiality*