Mortality as a Metaphor

“They say every blow that life deals you is a lesson in strength. There is not a soul on this earth who has never wondered why some receive extra lessons at no charge.”

– Susan Sontag, ‘Illness as Metaphor’

Till I joined a government hospital as a doctor, I was under the delusion that pain is a positive experience – that it builds character, makes you stronger and prepares you for the distasteful intricacies of life.

But sometimes, pain is just pain. It might not kill you, but it can leave you weaker, in a comatose state between life and death where you become an audience member of a world you can never truly participate in.

It hurts meaninglessly, unreasonably, metastasising into your future as if grief too was some sort of cancer. In hospitals, you understand that karma is a myth, bad things can happen to good people without any justifications, and what has never gone around can still keep coming around one more time. Like alcoholism. Like heart attacks. Like stillborn babies.

Faiz Ahmed Faiz was right in the beautiful song he wrote after reading The Communist Manifesto – that there are indeed sorrows in this world far beyond the anguish of love. This made much more sense when my five-year relationship with Mohit* ended, while I was working 120-hour work weeks. I hadn’t had the time to weep. Unlike the haemorrhages and clotted hearts, personal mourning could wait.

I started my days staring at the worn-out walls of the hospital, stained with spit and vomit, precisely reflecting the mess I felt inside. Bloodless faces of sleep-deprived mothers and worm-ridden children crowded the dimlit corridors. Their despair was palpable, their pain was cliched, their short life expectancies were normalised. A lifeless fan sluggishly chopped the air, which was heavy with the sullen anticipation of well-being, death, or something in between.

My broken heart looked like a joke compared to the ones unable to beat. Fluids dripped into the collapsed veins of grandmothers who had been widowed for as long as anyone could remember. Stretchers wheeled in and out carrying people not lucky enough to have the option of moving on. “No matter how many deaths you witness in a day,” I overheard two of my colleagues saying, “it’s strange how no one ever gets desensitised to it.”

I felt the same for love. Except that unlike relationships, life doesn’t offer a rebound.

The caretakers were always women. The cirrhotic livers were always men, resorting to addiction early in their lives for a transient escape from poverty. The corner bed had the patients with HIV; mostly migrant labourers who came back from long wage-less days to dark dungeons damp with destitution and perspiration. It seemed disease and death also had a social class. New born babies turned different shades of blue in the floor above and below, dilating pregnant women were being rushed into labour rooms where gynaecologists instructed them in a chorus to push harder. Umbilical cords were cut, anaemic exhausted mothers smiled in relief before slipping into slumber.

Also read: Pandemic and Pandemonium: A Doctor on India’s Kafkaesque Medical Reality

Somewhere in the other block, cancers were returning. In the ophthalmology department on the opposite side of the road, cataract knives cut open corneas that had seen it all. Mornings were filled with hope, afternoons were spent waiting in queues. Pulses dropped by the evenings and nights were reserved for wailing.

In medicine and otherwise, it is necessary to intervene at the right time. Unless, your patient or relationship was on a support system for a long time – in which case it doesn’t matter.

Susan Sontag had advised against turning illness in metaphor. She said that there is nothing more punitive than giving a meaning to a disease. But it’s hard to remember your principles when there isn’t a partner to talk about them.

In the nights, I smoked by the window and listened to Eddie Vedder. It’s difficult for lovers to distinguish their music tastes from each other when they have dated for too long. Lonely street lights stared into oblivion. A drunkard had passed out beside an open, overflowing gutter where banana peels floated and mosquitoes laid their eggs. A few street dogs were organising themselves, plotting something secretly.

Long nights allow me,’ sang Vedder, ‘to feel I’m falling… I am falling.’

If you have worked long enough, you know which cases will be admitted every Monday. Warm-blooded youngsters will drink pesticides out of spite after family fights and end up here retching and hypotensive. Little children bitten by a viper or common Krait, will arrive dizzy, sweating and salivating. There will be newly-wed brides with more than 80% third degree burns and drunk drivers with their skulls burst open, pelvis broken and blood soaking their lungs. A woman with puffy eyes and ankles will be perpetually waiting for dialysis. Stethoscopes try listening to heart valves flapping and clicking while in the next room, nurses giggle as they prepared the injections. A cuff tightens around a man’s brachial artery, ambulances skid into the front gate of the emergency building, policemen yawn and dig toothpicks into their gums while staring at a man catcalling some ladies. Dust flies. Heat roasts the bark of trees.

Illustration: Pariplab Chakraborty

I pulled out my phone out of my bag but suddenly realised there was no one to call. Habits, unlike promises, are difficult to break.

I saw life slowly withdrawing from the patients. Smooth, undramatic, permanent – like the way one falls out of love. At one moment, the pulse changes, from being felt like a distinct throbbing to a damped vibration – as if something which had been running for years is coming to an unexpected halt. The patient gasps for breath like a fish taken out of water, his hands and feet turning cold and pale. Penniless wives cry, beating their chests, breaking their bangles by hitting the floor, calling out their husband’s name and waiting for a response. Then, the oxygen cylinder is taken away, the vein flaps undone and marriages end just like that, with no one choosing to leave. Nothing is fair in love and war.

The worst of all was the posting in the neo-natal ICU. An abundance of little kids crying together in an inaudible, adorable sound. So pretty and pink, easy to intubate, smiling a meaningless smile. Their files had their ages on it: day one, day four, day seven. Their mothers anxiously waited outside the ICU, breasts heavy with the milk that their children could not suckle, only to be told after a week that they didn’t make it. They carried the little bodies of their dead sons and daughters, wrapped in a piece of cloth like presents, only to lay them down in little coffins. Some mothers never dropped a tear. They quietly buried the children and walked back home with straight faces. But days later, in the middle of cooking lunch or farm work, their cesarean stitches would hurt and they would break down.

In hospitals, however, healing comes. The defining characteristic of a living organism is not suffering, but striving and I could witness how. Wounds filled up, fractures were fixed, cyanosed babies revived and suicide attempts reversed. The people stood in solidarity through the suffering, the anguish and the second chances. They smiled and made plans. They held on despite the uncertainty. They learnt living with the diabetes, the cardiomyopathies, the schizophrenia and transplanted kidneys. Human beings are resilient, persevering and sometimes, lucky. I had always comprehended the pain of my patients but for the first time, felt a fraction of it too. I also learnt that the presenting symptom of sadness was stillness, that death could be told from one’s eyes and the first step towards recovery was the acknowledgment of your own pain. The crying out, the weeping, the calling for help.

When my shift got over at ten in the night, I came back to my room, made a margarita and put on some songs by John Mayer. I thought of the 12-year-old girl who died of a heart attack, never having gotten a chance to even dream of true love. I thought of the old man with dementia who had forgotten all the good times of his life; his wedding day, the birth of his twins and 40 years of studying mathematics. The lady who had her first born after years of trying but was clearly devastated on discovering it was a girl child.

Indeed, there are sorrows greater than the anguish of love, and one of them is the limitations imposed on our capacity to love by our memory, physicality, distance and prejudices.

It’s not the storm before the calm,’ sang Mayer, ‘this is the deep and dying breath of, this love that we’ve been working on.’

In the hospital, where time slowed down, patients waited for miracles to happen. Thousand of miles away, I imagined Mohit tossing and turning in bed before falling asleep, snoring loudly and dreaming vividly like he used to.

While I lay down and waited for the tiredness to overwhelm me, I wondered which one of us introduced Mayer to the other one. Lost and unable to figure it out, I burst into tears.

Bijaya Biswal is a doctor and social activist working for LGBTQIA+ rights in Odisha. You can find her on Twitter @bijaya_biswal

Featured image: Pariplab Chakraborty