Honor and Respect in Death

Within a few minutes of starting the clinic we got news from the village nearby that Mrs. M had passed away. The news of Mrs. M's passing was constantly in the back of our minds as we went about seeing patients and treating them. We had a full clinic that day and immediately following the clinic, we had committed to conduct a medical camp for children who were orphaned by COVID 19 in the nearby region. We were unsure whether we would even finish clinic early enough to head to the camp. But surprisingly the clinic slowed down and closed sooner than we expected. There was time to visit Mrs. M's home quickly before we can head to the camp. My colleague and I went in her car and as we neared Mrs. M's village, my heart started racing. I have witnessed so many deaths of patients, relatives, friends and even students, and have attended funerals. But it never gets easy. With a lot of trepidation we reached the village. It was not difficult to spot. Mrs. M's home is right on the road. There was a tent made of cloth as a shelter laid out just outside her home and plastic chairs were arranged. Several elder men were seated on these chairs and talking to one another. Just outside Mrs. M's house we could see the ice box placed and over it several marigold and rose garlands. People who visit funerals go with these floral tributes to the departed. My friend and I had just gone right from the clinic. I was beating myself up in my mind, "How do we go to pay respects to Mrs. M without even a garland?" But then we were already out of our car and it was too late to get back and go away. Even as we stepped out of the car we could see several young women, children and young boys stop whatever they were doing and staring at us. It is difficult to stay obscure in a small village when you land in a car and when you are dressed the way you are in clothes that show up that you are from the city. We had to park the car a few meters away from Mrs. M's home and so had to walk towards her home. The entire village was immersed in the mid afternoon silence, as though marking the mourning for Mrs. M's death. We would have just taken a few steps and suddenly drums started beating, and some jubilant music started playing. 

In Tamil culture it is customary to celebrate the life of the departed by playing rhythmic music and dancing to it just outside the home of the dead, where they are kept for family, relatives and friends to come and pay their respects. The drummers and dancers are hired for the entire time that the funeral visitation and respects are completed and they continue to play the drums and dance to the rhythm  during the funeral procession. The dancers are also fed alcohol to keep their spirits high (apologies for the pun). Each time someone important comes to pay their respect, the drumming and dancing starts and reaches a crescendo. Once they leave the rhythms slow down and stop. I have seen this happening so many times in the local villages. My friend and I were shocked and a bit disturbed by all the attention. As we neared the home of Mrs. M, we noticed that 6-7 transgender women were dancing just outside Mrs. M's home. This was another tradition in the local villages. It is considered a blessing to have transgender women dance in marriages, child births, funerals. We stepped into Mrs. M's home and stood in silence near where she was placed. 

Mrs. M was a long term patient of ours. I have been seeing her for more than 15 years now and my friend who joined the clinic about 8 years ago, took over her care and has been following her up since then. She had diabetes, hypertension and coronary artery disease. She was on conservative medical management. When she started coming to our clinic long ago, she was a very active and dynamic woman. Then gradually we saw Mrs. M deteriorate in health. Over the past year she developed a very stooped posture, weakness of her lower limbs and difficulty in walking. Even when she was finding it extremely challenging to move about, she would never miss coming to the clinic. Every Sunday like clockwork she would reach the clinic. Sometimes she would hitch a ride with some youngster who was going to the nearby town for work in their bike crossing the clinic and at other times she would just take an autorickshaw. She was friends with everyone in the clinic. She would walk in with a lot of authority, go and lie down in the cozy and comfortable bench just behind the clinic and wait there to be called during her turn. She would even demand hot tea from our housekeeping staff and have it while waiting. 

Interactions with Mrs. M have always been instructive and informative.  Mrs. M was a veteran community health worker. She was one of the refugees from Sri Lanka who came by an illegal vessel across the sea and settled down in Tamil Nadu. She would recollect her days as a dynamic community health worker during the emergency times. She had received several awards for being the person who 'motivated' maximum number of men to undergo permanent sterilisation from the local villages. She would show me her awards and citations with immense pride. She would also recall how several doctors had her phone number on their speed dial list. She was a translator for patients who came for medical tourism from Sri Lanka, as she had the distinction of speaking Tamil and Sinhalese. She once told me how doctors would send cars to her village, pick her up and then drop her back in the village after all her translation work was over. One of Mrs. M's reasons for sadness towards her last days was because she was a woman who was used to receiving so much respect, admiration and was constantly wanted by so many people for her skills till her late 60s. But when she became weak due to aging, everything stopped and she was discarded like a worn out object that is of no use anymore. Visiting the clinic, meeting us and talking to us about her glorious past helped her find vestiges of her self respect and honour. Sometimes we would wonder how she musters all the mental strength to even get up and come to the clinic given her debility and complete dependence on others. But then, being in the clinic helped her reconnect with the times when she was a happy and busy woman and that was probably the only thing that kept her going. 

Mrs. M repeatedly kept insisting to my friend, that she must visit during her funeral. She was someone who cherished being respected and honoured. I still remember how angry she got when her name was left out by mistake when our NGO honoured all the senior community health workers in the local villages during our 40th founding day celebrations. She was so furious when she sat in front of me and scolded me, "How dare you forget me. Other useless women who learned the skills from me got honoured and you left me out?" One of her biggest worries must have been dying as an unwanted person who nobody mourned. It was an honour for us to pay our respects in her funeral. Mrs. M lived a full life with grace and honour and exited the way she liked, with respect and honour and celebration of her life. She died on a Sunday, the day we would be in the area to visit and pay our respects. If it had been any other day, we wouldn't have been there and it was unlikely that we would have gone. By some strange coincidence we got to know about her passing the same day. There have been so many occasions when we have only heard of our patient's deaths after several days. It also happened that the clinic closed early and we had the time to go and pay our respects. It all seemed like the Universe conspired to help Mrs. M get the honor and respect that she wanted so much in her funeral. This blog is dedicated to Mrs. M, and her zest for life. We will miss a regular client in our clinic.