The Forgotten Meaning

The building stood against a backdrop of dusky sky and orange trees. The fallen autumn leaves raced to the boundary as though dodging the breeze. The marble porch, the sliding doorway, and the immaculate lobby impressed the medical student, who had come to this palliative care center during his primary care rotation. A large portrait stood against the hallway, showcasing the illustrious work of an unknown artist—the colors seemed to have come alive on the canvas only to be held back on the spot by the glass case that so snugly covered it.

The medical student moved towards the reception area and explained his business to a hunchbacked receptionist. He was signaled to go to the second floor and meet the medical officer on duty. He made a turn to the left towards the staircase; he saw an elevator adjacent yet decided to use the stairs instead. By now he had noticed the eerie silence as his footsteps reverberated from step to step. He tiptoed a few steps to dampen the sound and just as he reached the second flight he decided to sneak a peek on the first floor. Silent hallway, no movement, muffled voices and the sound of shuffling pages behind a counter. Silence was so prominent…he could hear it scream. A thought came to his mind but he quickly brushed it off as he was stirred back to reality by the mere whisk of the janitor who was cleaning the double-pane window across the staircase. He shifted his glance to the view outside just as a leaf so silently dropped from a huge tree making its way down in twirling motion before finally disappearing from the medical student's view. Not a sound. Not even a cry…. He drifted back to present time and made a quick trot up the second stairs. He wanted so desperately to hear something…but nothing except silence.

He made his way to the floor counter and met a man in a plain shirt who turned out to be the medical officer. Fortunately he had a chirpy voice. Thank God, thought the medical student and scratched behind his ear momentarily. The medical officer explained that since this was a palliative care institution, most people were spending their last moments on the floor. “I would like to give you a relatively stable patient so that you can clerk him, but please remember that you need to ask gender, culture, and situation-appropriate questions. Would you be able to do so?” Suddenly the medical student felt that his stomach was empty yet a sense of heaviness ascended up his epigastrium. “Umm…sure,” he managed to say, unsure about anything at all. The medical officer thrust a file into his hand and told him to go to the men's ward, left of the counter. He bit his lower lip and with a heavy heart treaded towards the ward.

With the conversation between him and the medical officer now over, there was once again pin-drop silence. What was this place, he wondered? The earlier thought that he had brushed off came back to him with speed. It reminded him of graves…. What if someone had been diagnosed with terminal cancer? Was this the life he or she deserved before eventually dying? This was like punishment for getting cancer in the first place…like a preparatory course of how to behave in the grave. Beautiful ceilings, dim lighting, and the most beautiful view across a glass pane could never replace the sound of a human voice, of laughter, of children playing…. This was a death house and no one could ever become happy living here. Who would if they had a choice come here?

The medical student inched towards his assigned bed trying to keep his eyes off other patients, whose miseries would engulf him even more, but the moment he made it to the bed he knew it was a mistake! A drowsy middle-aged man with an intravenous cannula on his arm probably running morphine and no hair on his head was his patient. His entire forehead was dark from sessions of radiotherapy and he was wearing gray hospital attire. His bed sidetables were devoid of expressions of human emotions—no flowers, no cards…not even a “tiffin box” of homemade food.

The medical student pursed his lips while trying to hold back tears. He remembered a prayer that his grandma had taught him when he was young about how if you saw someone afflicted with pain, then you should thank your Lord that he had saved you from it and not given you the same out of His own mercy. No, this was not enough; he wanted to do something for this man. He wanted to decorate his bedsides with flowers, cards, children's drawings, leftovers of homecooked bread, chocolates, candy wrappers and bunties, give him colorful home pajamas to wear, cover his bare head with an enormous wig, and bring his family and old friends to meet him and spend the last moments of his life that were evaporating from him so swiftly, much like the beads of sweat on his shiny hairless head. So much for medicine and palliative care; science was really the miracle: it had turned his life into a living death.

The medical student could take it no more. He made his way to the medical officer who now happened to be in the ward behind the nursing station, reviewing evening medications. He would let the medical officer know the truth about this pathetic institution—how it brought into view the death that was so imminently near. He had to do something about it…overhaul the system…bring the management to book, and—just as he was about to say it, the medical officer looked up from his formulations and asked, “You've got that evaluation form, haven't you? The last time a student came from your institution, he forgot to have it filled out by me. Give it to me so that you won't forget.” The medical student's hand reached for his coat pocket as though he had been automatically programmed and after handing the form over to the medical officer retraced his steps to his patient without a word. He gulped down as he once again stood in front of the lifeless form, making small talk in an effort to take a history. A physical examination on him would be torture. So much was his grief that the only compassion he could manage was to not bring him the worse memories of his illness or touch his body for the 40th time in odd maneuvers just to let him know that death was pretty much all that could be assessed.

Finished with this futile exercise for the mere sake of his pointless evaluation, he sat on the bed of the dying man and reached for his hand; he caressed his head where not long ago sat a worthy lock of hair…. And then he felt it…the patient's hands that had felt so cold when he had touched them first, now exuded a kind of warmth that he so distinctly sensed. This patient didn't need medications during the hours of his fleeting life…he needed some pure unconditional love, even if it be from an unsuspecting medical student. His evaluation was not more important than this man's transitory life. Yes, but one day this very meaningless evaluation would cause him to eventually overhaul a system that had forgotten the true meaning of palliative care.