When Abu Died

ICU ? Abu ? Had I heard right ? Dazed, I gathered enough energy to check out how much money I had in the cupboard. I shoved it all in my purse. Still unbelieving, I hurriedly hailed a passing rickshaw and rushed to the hospital. “Abu, Abu”, I blurted out to the man sitting at the counter. I had never before been inside a hospital. The receptionist guided me to the ICU. I walked cautiously. It’s true then, I thought to myself. Abu was indeed in deep trouble. I didn’t know what an ICU looked like and my pulse raced as I asked one of the nurses where he was. The smell there was so strange, so unfamiliar. She pointed to a still form lying on a bed, covered by a sheet. I couldn’t recognize Abu. There was some kind of tube coming out of his mouth. It was a flexible pipe (like that of a washing-machine), actually, and it led to a machine by his side that hissed rhythmically.

“He’s on a ventilator”, the young doctor beside me said softly. There were wires stuck on to his chest which were attached to a monitor that indicated the beating of his heart. Bottles hung on stands on both sides of him, feeding some fluid into his system via his veins. What had happened ? My mind was too dulled to react. My favourite cousin, who’d turned thirty last month, was lying motionless, dependent on these gadgets, unconscious. What happened ?

“What’s happened ?”, I kept asking aloud. Someone escorted me out. I think it was one of the staff. Not sure. The policeman in the Waiting Room told me the details. Apparently, whilst walking back from work, he was hit by a passing vehicle, and his head had dashed against a pavestone. Passers-by picked him up and rushed him to the closest hospital. And that was about 8 hours ago. They had not found anything on him to indicate where he worked, or lived, for he wasn’t carrying a wallet on him. Strange, I thought. Then I guessed even under shock, that someone might actually have picked his pocket. How could people do these things ? Anyway, on the cover of a book he was carrying, my number had been scribbled, and that was how they had traced me.

“We need some details from you,” the policeman said. Very mechanically I gave the him Abu’s name, address, next of kin, phone number, age, whatever he asked me for. My voice sounded strange, but controlled. As I spoke, I simultaneously wondered how I was going to tell all this to Seema, his wife, and my best friend.

“That’s all,” the cop said when he was through. He added, “ You need to call someone from home.” He was a helpful, polite man, I must say.
I stood for only a couple of minutes by the phone booth, then dialed the number I knew by heart. And I spoke like I was talking about someone else, not Abu. I did not mince words but my voice was very husky, very low. I told Seema exactly what had happened in the last hour or so, as I knew it. I spent five coins whilst the phones at both ends had long moments of silence. Seema said nothing, nothing at all, just “yes?” or “hmm?”. My mind was clearing up, hers was getting numb. Had I done the correct thing by telling her this news over a phone ?

“Seema,” I was calmer now. No response from her end. Had she fainted ? “Seema,” I called into the phone, a little louder.

“I’m here,” she spoke softly. “I’m coming over. Wait for me.” And she put the phone down. It was agony, waiting for her to come.

All our lives we’d been open and honest in every deal, every way, I could not now, under duress, change that habit. It was part of our nature. Now people tell me that that was not what I should have done, but I was in no condition to think then.

Whilst she was on her way, my mind danced from event to event in our lives. Seema was my classmate, and my cousin Abu was six years our senior. He stayed with us for his studies whilst his parents were away on postings to remote areas. I went along with him to visit them during the vacations. Telling them was going to be difficult, because …well, because I’d never had to give anyone bad news before this. I was ruminating on all this when I saw Seema enter.

She didn’t make a fuss. Her face, her mannerisms, all displayed nervousness, her voice was reduced to a whisper, and she certainly looked ill. But true to form, she was not hysterical or anything. I repeated what I’d told her over the phone. I wondered aloud whether this was the right time to give my uncle and aunt a call. Or maybe I aught to call up my parents first. Or hers ? She was quiet, placid. Suddenly there was a call for me from within the ICU.

We both ran in. I will always remember that young doctor’s voice. It was hoarse; he was looking at us. “This is Seema, his wife,” I introduced.

“I’m sorry to have to tell you, the patient is no more.” That’s all he said.

I blew a fuse then. Was he mad ? Was he really a doctor ? Abu’s chest was heaving, the monitor showed a heartbeat on the screen, how could he declare him dead. No more ? Not alive ? I wanted a second opinion. Seema was silent, just staring at Abu. I’d forgotten that she hadn’t seen him thus, she hadn’t entered the ICU until then, and I felt bad that I was raising my voice, but I demanded to see a senior doctor, someone more responsible, more knowledgeable, someone who could see that Abu was breathing, not dead.

Someone took Seema away. She kept staring at Abu, still quiet. A soft female voice by my side said, “How was he related to you ?” Was ? Why was this woman using the past tense ? She guided Seema and me to a small room by the side of the ICU.

“ I am a co-ordinator here, my name is Anuja. Are you two alone here ? Have you informed any other relatives ?”

We shook our heads. She offered us her phone and actually told us what to say, for we were at a loss for words. I called up my parents.

“Tell them you are calling from this hospital, say that you are waiting here for them, that Abu’s injured, there is no need to give them the detailed news on the phone. Please speak calmly.”

I spoke so mechanically, that I was sure they would have guessed what had happened. Anuja got us glasses of water, and I saw Seema looking less pale now, but her eyes had begun to moisten. She refused to talk on the phone although I offered the instrument to her. Once the call was disconnected, we went out again into the visitors’ area and sat in silence, side by side, holding hands, waiting for the elders to arrive. I knew my parents would have informed Seema’s and Abu’s, too. Time seemed to stop. I saw the others in the waiting area moving around, but didn’t register anything. I noticed trivial things like the clock on the wall was a couple of minutes faster than my watch, that the plants weren’t real, that the magazines were actually new ones and someone had scribbled names of doctors and medicines on one of them.

When the elders did come, and they came together, our silence continued. It was an unbelievable situation. Actually, they came to the hospital with the impression that the injuries were minor, and were ready to scold Abu for being reckless on the road. Our silence warned them that something was seriously wrong. To say that they were shocked was an understatement. But, as with Seema, they did not make a fuss, either.

“Where’s he?” Seema’s father asked. We just pointed towards the ICU. They went in. Seema and I stayed where we were. They were gone for a long time.

In the meantime, Ms Anuja, the hospital co-ordinator, had been talking to us soothingly, and we were able to gather our thoughts together. She asked us many questions about him, our families, our jobs, and then came back to
Abu’s death.

“How,” we echoed, “could the doctor declare him dead when he was still breathing ? We can see the chest moving, we can see the heartbeat monitored.”

“ You are familiar with cardiac death. When the heart stops beating, the person is no more. Well, similarly, when the brain stops functioning permanently, also the person is no more. Abu’s heart is beating because the doctors are artificially maintaining blood pressure and because of the mechanical breathing via the ventilator. This mechanical support of a dead patient can’t keep the heart beating for more than a couple of hours anyway.”

“How can you be so certain ?” I asked. “Why can’t we ask someone else ?”

“ There are certain tests which are done that differentiate between coma and death. A patient in coma is alive. He gags if a spatula is inserted into the throat. His eyes move if ice-cold water is injected into the ear.” I noticed from the corner of my eye that Seema was concentrating on every word the lady said. “ There are other medical tests besides simple ones like these. Besides, a patient in a coma, if on the ventilator, may at some stage be able to breathe on his own. A dead patient is, as I explained, moving only because of the machine. The instant it is switched off, the heart will also stop.” Seema gasped and I held her hand again. She squeezed it and then let go.

Before I could ask Anuja any questions, she continued, “These tests are done as per the law by two different sets of specialists after a mandatory gap of six hours before declaring death.” I calculated the time that was told to me. Yes, more than six hours had certainly lapsed since Abu’s accident. So these people had done these tests she was talking about. Seema obviously thought of the same thing because she had instantly looked at her watch and gasped again.

Anuja continued: “Brain death can occur in persons who have serious head injuries, certain kinds of tumours, excessive bleeding due to an aneurism, drowning, or overdose of certain drugs.”

We were letting this sink in when Abu’s parents walked in. Seema’s folks and mine followed them. Pale faces all. We sat silently whilst Anuja took them inside the small room at the side. There she made them sit whilst she soothingly repeated everything she had told us. Seema and I were called in after she had finished talking to them.

“Is there nothing we can do ?” we asked, aghast and still unbelieving. This was the first time we had heard of brain death. The doctor had declared him dead even though his chest was heaving, and we at least now understood why. All were crying and sniffling by now. And praying audibly. “Nothing at all ? We keep reading about miracles. Please help us.”

What she said next was the strangest thing I had ever heard.

“Yes, Abu can live on, but not as you imagine.” We were instantly alert.

“How ?” we chorused. We were willing to take any chance, however remote. “Don’t worry about the money, we will manage that”.

“ It has nothing to do with money, and it will not bring Abu back to you. But he is in a position to give life to others.”

We were puzzled. She went on.

“Not many people die of brain death. Not many have even heard of it, as you hadn’t. But such patients are the only ones who can donate their organs. Not every one gets such an opportunity,” she said.

I recalled Aishwarya Rai on tv. She had pledged to gift away her beautiful pair of eyes after she died, and had let the world know it, to set an example. So had A Bacchan and Kapil D. I told Anuja we’d seen that advertisements.
“You have ? Between them, 6 blind persons will benefit. Should they donate their organs as well, at least 15 other human lives can be saved. Because, kidneys, hearts, livers and pancreases can also be thus gifted after one is no more. Abu can donate all of these if we hurry.”

Confused, we looked at each other.

Gently, but rapidly, Anuja gave us a lot of information. And we listened carefully with a sort of morbid curiosity. We were new to all this.

“All who die except those who are suffering from infectious diseases or certain cancers, can donate eyes and skin, provided the retrieval is done correctly and within 5 hours of death, even from home. Of the eyes, only the corneas are used. Certain layers of skin are used for severely burnt patients. From brain-dead patients, whose circulation is maintained, organs like the kidney, heart, liver or pancreas can be taken for patients who suffer from malfunction of the same.”

“Those whose kidneys have failed can resort to an expensive but partial treatment, dialysis. With the other organs, there is no alternative, transplantation is the only choice. Since the kidney is a paired organ, a living person can donate one quite safely. Legally, in India, only a blood relative can do so. Medically, too, that is the best option as the tissue match can be very close. Buying kidneys from unrelated living donors is illegal. However, the family members have to be fit to donate. If the blood group is different, or the tissue doesn’t match, or the health requirements aren’t met, what does a patient do? He or she has to depend on a cadaver donation.”
I don’t remember all of it verbatim, but having gone through what followed, and having done tons of homework on the subject subsequently, I am able to give a gist of what she said.

“If the organ is a single one, like the heart or the liver, there’s no question of having a living donor. In such cases, cadaver transplantation is the only answer. And only brain dead cadavers can donate these organs. The Transplantation of Human Organs Act of 1994 has been the only act passed by parliament that was done without a PIL and by unanimous consent.”

We didn’t want to hear any more at that point. Except, surprisingly, Abu’s mother, my aunt. She wouldn’t take her eyes off Anuja and, in spite of the tears flowing ceaselessly down her cheeks, she wanted her to talk on. She wouldn’t be dissuaded. So we had no choice but to listen to Anuja. All the while, one or other of us would step out and take a peek at Abu, to make sure that no machine was switched off. And we said so to Anuja.

“No,” said Anuja, “the machines will not be disconnected.” We were relieved.
And Anuja continued. “There are recognised hospitals that are authorized to carry out such transplants. We have a list of those suffering from organ failure. They are waiting for organs because that is their only hope to live.”
“You know,” sobbed Abu’s mother, “ When Abu was in college, he had donated blood at a camp. And he had said he couldn’t understand why people were afraid of giving blood. If one could help another, why not. He had said he admired soldiers who could give their lives to ensure that others’ lived well. He had wanted to join the Army.” We clung and wept when she reminded us of how he had failed to clear the medicals after the entrance exam and how we had laughed off his disappointment.

“Would Abu have liked to donate his organs? Had he spoken about it ever ?”
No, never. Whoever spoke of death? Funny thing, I thought at the time, I remember, that one really didn’t know how one would die. ..and one had to die someday. No-one ever spoke of their own deaths. It was discouraged. I wondered how I would die. Then almost instantly, I wondered what was to be done next, about the funeral and things. Obviously, each of us was contemplating something or the other and we weren’t paying any attention to Anuja’s lecture. I suddenly heard Seema’s father ask something. My father objected to it. I wasn’t paying any attention. They were having an argument of sorts.

“….You need to think of Abu’s parents…..”

“No harm in hearing her out.”

“Are we really concerned about these things?”

“ Shouldn’t we at least know what is possible and what isn’t?”

“Be practical, we need to make,….you know,…..arrangements.”

Abu’s father choked as he asked Anuja something that I couldn’t hear. But I can recall Anuja’s reply.

“……of course. The blood group is checked out and tissue matching done.”

I didn’t want to hear any more. All of us were very, very quiet, in great distress. We didn’t know what to think. I wished Anuja would go away. As if she’d read my mind, she did get up and go. I watched her step out. With great effort, I followed her, then turned back to the ICU and went and stood by Abu’s side. There was no doubt that in spite of the heaving chest, he was no more. The tongue was out, the eyes blank. I had read about brain death, long ago in a newspaper article, maybe, and I knew it was true. I didn’t want to believe it, though. Panic rose and rose within me. If the denial in me was so strong, I didn’t want to know what the others were going through. They had followed me. We stood around the bed in silence, gazing at our Abu, our minds quite devoid of thoughts, our hearts heavy, our eyes wet. When a person is alive, there is so much one takes for granted. It was so difficult to see Abu lifeless, just lying there.

Another patient was wheeled in and we had to make space for the bed to be turned.

The doctor who had declared the death came and stood by us. I asked him, “ How long will this machine go on ? “

He said, “ A couple of hours at the most.”

Seema pleaded, “Can’t you do anything ?”

“No, Ma’am,” he said, “The patient is no more.”

“Then why are you keeping him on that machine ?” there was a trace of rising hysteria in her voice now. We huddled close to her.

”Until the heart finally stops, we will not switch it off, although there is nothing we can do.”

Seema hiccupped and we helped her walk away from there. We went back to Anuja’s room for in the visitors’ area we would have had no privacy and we did not want to be surrounded by strangers. The grief was so heavy our shoulders began to droop. My mother, ever the practical type, broke the silence. “What do we do now ?”

They began to discuss whom to contact, who would go home, etc, in a very matter of fact way. I couldn’t make out what was going on in Seema’s mind.
“She said Abu could live on…” Seema’s whisper reached all our ears.
Extremely hesitatingly, her parents went to her and said, “No-one comes back. We have to accept whatever is written in our fate.” They turned to me and suggested that we must go home.

Now it was the other important woman in Abu’s life, his mother, who repeated that statement: “She said he can live on.”

The two who were closest to Abu were the ones who were keen that he live on, even in death, through others doomed to die. If a part of him would live on, they wanted it to happen. I guess I understand that now, in retrospect. At the time, I couldn’t fully comprehend that sentiment.

Her husband almost choked the instant she said that, and made jerky movements with his hands. “Abu is gone, gone.”

Seema’s father gently added that Abu should not be subjected to more trauma. He had faced enough injury. They now needed to tackle the misfortune that had befallen them without complicating matters any more.
Seema and Abu’s mother wanted to meet Anuja again. They were adamant. I called her back, fully aware that my parents’ sorrow was beginning to have chinks of irritation that the two women seemed to be getting unreasonable. My mother whispered to me that I better get a taxi and take them home until she and Baba did the needful. I ignored that, and went out to find Anuja. I wanted to do my bit to comfort the duo, and inside me, somewhere, I found the whole thing reasonable.

When I entered again with the co-ordinator, I knew that they’d been discussing this organ donation business intensely. Everyone was red-eyed and misery was written on each face. The air was heavy with sadness and uncertainty.

My father was saying, “ …. aren’t sure about whether our religion allowed rituals with ‘incomplete’ bodies, with so many organs removed. There will be mutilation, unnecessary expenditure. Be practical. …..never heard of such a thing…..”

Seema’s father was pleading with the others to go home, go soon, he could manage alone,….

In spite of crying bitterly, Seema seemed firm about asking Anuja more questions. And it was Abu’s mother, sobbing violently herself, who was taking her side. “We’re not going home,” both declared firmly.

There was chaos as voices began to rise. Strange how perfectly reasonable people who have never had any major differences, behave in unexpected ways under pressure.

Matters weren’t improving at all as the three sets of parents began to argue, even about things that weren’t quite relevant here. After a couple of seconds, Anuja took things in hand.

“I need to speak to the wife first,” she said firmly.

“My daughter will not be able to handle this,” Seema’s father interrupted.

“Don’t you underestimate me,” Seema snapped. And the very next instant fell into his arms crying inconsolably. Her mother stepped up and told Anuja not to hurt her any more.

“No, Ma,” Seema forced herself to sit again. “I want to know more. I don’t want my Abu’s life to be wasted.”

Her mother-in-law, very weepy, but just as determined, came and sat by her.
My father betrayed his annoyance when he said, “Our religion does not permit this kind of cutting up of a body. It’s not right. We can’t do rites on an incomplete being.”

At this my mother, ever the non-diplomat, blurted out: “I’m incomplete too, I’ve had an hysterectomy. Which means my body is incomplete. And you’ve had your appendix taken out and two teeth.”

Morbid humour, but it put things into focus.

It was a valid argument, though. There was still a long, heavy silence. Abu’s mother went back to Abu’s bedside and stroked his head. When she came back, she said, “Abu may have wanted it thus. It is the ultimate gift, of life, of sight. If his life is gone, it was our destiny, his fate. We can’t change that. But if we can change someone else’s life, this act of charity…I would like his organs to live on.” All of us sobbed uninhibitedly.

Abu’s mother insisted that she wanted her son to live on. Seema took up the same chant.

Finally, we all asked Anuja to tell us some more.

Seema looked stunned and kept looking at Abu’s mother. Later she told me, “How well she understood Abu. Yes, it was easier…. It was much easier to accept his loss knowing that somewhere, his kidneys were living on… that through his corneas someone was seeing the world.” I agreed with that wholeheartedly. Yes, it had made that senseless, sudden loss meaningful.

All of us discussed the religion bit, too.

By then many of our neighbours and relatives had arrived at the hospital and there were several others who gave us their points of view. All agreed on two things: that it was the ultimate act of charity and that Abu would have liked it that way.

Much later, a lot of people asked us the whys and whats of our decision. We’ve taken pains to explain our point of view. What was the point in burning those organs, he didn’t need them in heaven, but god knows they were needed here. . . We found out, also much later, that those who received the organs were carefully chosen. The age of the receiving patient was taken into consideration as also how long the patient had suffered from the ailment. Points were given to each category (there were other criteria besides the ones mentioned) and the patients who had the largest number of points were told to rush to the operating theatre for the transplant. We had been assured, also, that the organs would truly be a donation, none would be charged for them. But when we took the decision, the guiding factor was that we wanted some part of Abu to live on, somehow, somewhere, in some way. We did not want to lose all of him.

To go back to that day. Once we were convinced that we couldn’t do anything better than this, we signed the consent form.

After that we did not pay for anything. Abu was taken to the Operation Theatre for removal of his organs. He was bandaged like any patient is post-surgery. It was neat….I saw it, too.

We called up after a couple of days to find out how and where the organs were. The law did not permit us to know the identities of the receivers. Anuja told us that there were no matching recipients for the liver and the heart recipient did not survive for more than a couple of hours. That was unfortunate. When we pray for Abu, we pray for those patients also. We don’t know the names of those who have inside them Abu’s kidneys, nor of those who are seeing through his corneas, but we are comforted in the thought that he does live on, that his soul gets blessed every moment of the day. Or night. Abu is dead, yet he lives on.