Spirituality takes over, when medicine stops working!

Mr. Madhukar*, a 57-year-old man from the lower middle socioeconomic group, was employed with the Bombay Municipal Cooperation (BMC). He had two daughters and a son. Both the daughters were married and the son was single. He was a resident of the suburbs of Mumbai while his office was located near the CST station in South Mumbai. His job required a lot of travelling.

In April 2021, he was diagnosed with metastatic papillary adenocarcinoma of the D4 and D5 vertebrae. Since then, he had undergone multiple lines of treatment at the Tata Memorial Hospital. The result was not so responsive as there were indications of increased disease burden. In August 2022, he was referred to PALCARE for supportive and symptom management; and on 8th of August 2022, PALCARE enrolled him into our free palliative care service.

When we enrolled him, he had sharp shooting pain in his back which got worse on standing or during walking. He also complained of radiating pain from the back to the legs, along with a sensation of pins and needles in the soles of his feet. Tata Memorial Hospital put him onto fractions of radiation. But that did not help much, as new investigations showed the disease was, in fact, progressing. Radiation eventually had to be stopped. As time went by, and the disease progressed, he found it difficult to walk. Earlier, he would travel to office in a local train; but this then became impossible for him. Eventually he stopped attending office and became house bound.

The PALCARE team worked upon a tailored care plan so that Mr. Madhukar’s symptom burden could be controlled. With appropriate medications, PALCARE was able to achieve adequate pain control. But with each passing day, he started developing greater weakness in both his legs. He would find it difficult to get up from a lying down or a sitting position. His legs started giving up and he became dependant on others for his daily activities like bathing, dressing, walking. Being an independent person, and now dependent on his wife and son for even daily activities, his distress levels became palpable. He felt that he had become a burden on his family members.

With every visit the PALCARE team developed a stronger rapport with the patient and the family. Mr. Madhukar was a very religious person. He loved providing food for the less privileged and most of all he loved singing bhajans. Every time the PALCARE team visited, he insisted they listen to his Bhajans and have tea with him. As the disease burden increased, his legs became increasingly weaker. He developed incontinence of urine and stool and our efficient PALCARE nurses instructed the family how to handle this.

The PALCARE team did its best to provide comprehensive care, beyond just taking care of his symptoms, by facilitating Mr. Madhukar’s active participation, as much as the situation allowed, in pursuing his hobbies of reading Indian epics and singing bhajans. In addition, he wished to spend time with Mother Nature, bathe in the sunshine, listen to the chirping of the birds, and enjoy the outdoors in general. His desire was fulfilled by our nursing staff who arranged a wheel chair and walker for him.

Having been an independent and decisive person, who had lived his life to the fullest, Mr. Madhukar was totally against a hospital admission or any “experiment”, as he called it, with his body. He did not want to die with tubes attached to his body. All he now wanted was a peaceful exit from the world in his own home, surrounded by his family members. Another of his last wishes was to find a suitable bride for his son, but this he could not do.

The cancer spread slowly but surely. Madhukar left this world in February 2023. A month before, he celebrated his 58th birthday with his family and friends. He recited his favourite Bajans on his birthday for all his guests. He wanted the PALCARE team to be there too, but since the team had other patients to attend that day, they could not be present. However, a video call was arranged, and he sang a beautiful bhajan for the team. It was an emotional and a lovely affair for all – team and family. At the time of death his wife, son, daughters, sons-in-law, and grandchildren were all present. He had a very peaceful exit from the material world, in his favourite place – at home.

* Mr. Madhukar is a pseudo name for the purpose of confidentiality*