Monday, December 05, 2005

The Deterioration of the Body

The body has to deteriorate and die.

The change can be sudden. One can suffer from an accident, or an acute infection or the malfunctioning of an important organ.

Even a slight disturbance in the body's systems, an eye infection, pain in a tooth, dandruff, a corn in a toe, a stomach upset can lead to a general feeling of malaise, of being un-well, of not liking to eat, of not being able to enjoy anything, of a lack of energy, listlessness, irritability and so on.

Good health is a gift which is seldom enjoyed consciously. Only in illness or in pain do we usually become conscious, aware of our body and wish for things to get back to normal...

The body has an innate intelligence which can guide the will to make decisions conducive to a quick recovery. Not liking to eat when ill is the body's way of ridding itself of toxins and of resting the metabolic system, for example.

Many of us spend an unreasonable amount of thought and energy in warding off imaginary illnesses, in keeping more fit than is required, taxing our bodies thinking that dis-use leads to dis-ease.

In the modern world, physical activity is mostly voluntary. We don't usually need to exert our muscles in our daily lives. That is why the plethora of gyms, the fads of yoga and various new-age therapies, the urban maladies (due to a stressful lifestyle and of a polluted, noisy and crowded environment) of chronic constipation, high blood pressure, stress, balding, early graying of hair, myopia, diabetes, back pain, obesity, acidity, ulcers, cysts and so on.

It is important to use the body and the various muscles on a regular basis. Just washing a few of one's clothes, or the dishes, or walking to the grocer and carrying the bags home, of climbing the stairs, a few minutes of aerobics or yoga asanas in the morning, an occasional set of push-ups or sit-ups or crunches can keep the body in good shape. Also important is moderation in one's diet and regularity in the food habits. Eating at almost the same time everyday, having a regular calorific intake, eating fruits and vegetables, having juices, not having many cups of coffee or tea or carbonated water, limiting one's drinking and smoking, not eating red meat, all contribute to good health.


Even so, no one can escape age-related degeneration. The eyes become weak, the ears hard of hearing, the muscles lose their stamina, the joints become weak, the bones soft, the heart frail, the brain not as active, the teeth start falling, the hair start graying and falling and so on.

If one is conscious of the body's needs and does not under-use or over-use it, the degeneration is slow and graceful. One frequently comes across a village-folk or a a hill-woman who is pleasant to look at even in old age. One may not look desirable, but there is such a thing as healthy old age in which one is not suffering but is just slowed down. On the other hand, most of the urban people look ugly in their old age, their gait ungraceful, their faces contorted with stress and a thousand fears and regrets, their bodies and faces displaying the tell-tale signs of a life lived hastily and restlessly and their talk becomes bitter, cynical and critical.

It is not hard to understand why such people would not be able to command care and respect from their children. Caring for a selfish, demanding, irritable, moody and cynical man or woman is not a pleasant chore. Is it a surprise why in cities, old people are seldom tolerated in the homes of their children? One can forgive the degeneration of the old person's body as inevitable but it is hard to live with a degenerate or manipulative brain.

I have had the opportunity of caring for many of my grandparents in my life. One of them died of Alzheimer's disease at the age of 85, the other of a heart attack at the age of 90, another of cerebral haematoma as a result of a failing heart, again at 85, and my grandfather, who died the last, died of right ventricular block at the age of 93.

It is not a chore to care for another if one doesn't have cares or desires of one's own. A hedonist will be ill at ease caring for another. He will consider caring for another as an imposition, a burden, an intrusion into his pursuit of pleasure. A depressed person will lack the will to care well. An impatient or emotional person will lack the stability and calmness to care without getting agitated. A person with strong likes and dislikes will easily get disgusted and lose his/her temper.

However, since almost all of us suffer from some care or desire, it is unrealistic to expect someone to care well for someone else for long. Even a mother gets irritated and angry at her child after a couple of sleepless nights.

If the prognosis of someone's illness (or the possibility of a treatment which might cure one) is not very positive, but the degeneration is not sufficientt to cause a quick death, depression might set in at the un-ending days and nights of care which await the care-giver(s).

Sometimes the care-givers resort to radical surgery to attempt to get the patient either back to reasonable good health and independence or to a quick detereoration and death. For the care-givers, death of the patient is only a half-tragedy. It is also a relief.

The ill person can also feel the demands he/she is making on the care-givers, and this can lead to a feeling of depression, of helplessness and of a tendency to suicide. As these feelings are not helpful for the patient's recovery, these lead to a progressive degeneration and to a demand of higher and more insistent care.

Hence, if care is sought to be given, it should be given joyfully. Otherwise it is counter-productive. In private nursing homes also, nurses are usually under-paid and over-worked. It cannot be expected of them to be considerate and caring at the same level as the patient's relations.

When a patient is terminally ill, assisted dying so as to minimize the pain, suffering and humiliation becomes a possiblity. As far as possible, the patient should be kept un-sedated. Sedatives, tranquilizers and sleeping pills can reduce the burden of care, but it also makes such aids mandatory for the future. It is a downhill slope from there. If a patient is unusually irritable or in pain, a mild anti-anxiety drug such as Alprazolam is prescribed. Efforts should be made to make the patient as calm, undisturbed and close to normal as he/she can be even when bed-ridden. A quiet and calm atmosphere, availability of reading material, normal conversation, a dispassionate attitude towards the bodily secretions can make the patient feel at ease and un-distressed. Analgesics (painkillers) should be moderated, as they can easily cause GI upsets. Some mild exercise involving the abdominal muscles can be beneficial for bowel movements. Natural/herbal laxatives (e.g. Isabgol and Triphala) and milk of magnesia are preferable to harsh contact laxatives.

In many countries, it is legal to give a lethal dose of tranquilizers (for example, a 9g oral dose of Nembutal) to let a patient die quickly and painlessly. In India, however, it is not legal yet. But if a terminally ill patient himself declines to have food or liquids, they should not be forced upon him as they might contribute to distress. However, adequate oral hydration (optionally with glucose and electrolytes) can be provided by asking the patient, as it causes little or no metabolic activity.

Hygiene for a bed-ridden patient should be maintained as far as possible as it can be a mood elevator. Mouthwash, sponge-baths, washing of the patient's hands and face before and after his meals, keeping his bed-linen clean and dry and keeping the room ventilated with fresh air, all contribute to a general feeling of well-being.

One might ask what is the purpose of keeping a terminally patient alive. And it is a difficult question. Most of us consider human life as sacred and a gift which should be maintained even when there is no value addition by the person alive to his environment. An old man of 90, who is bed-ridden, can continue to live for many more years if proper care is taken of him, without him being in any way enjoying life, learning anything new or adding anything of value to his environment or to his care-givers.

So what can be the justification of caring for him? Sometimes people do it due to feelings of obligation, filial respect and piety. Sometimes, due to a fear that they themselves might one day face the same and so they should do their part (and subconsciously expect the same care when they reach old age). Sometimes people think that giving care is a good deed which will be rewarded in due course by God.

I took care of my grandfather and others because I had time on my hands, I knew (or learnt) how to care, I had a superficial knowledge of physiology and medicine, and I wanted to learn about old age and death. I am not sure if I would have been willing or patient enough to care for them for years and years while they were bed-ridden. The longest period when I took care of a completely bed-ridden patient (my grandfather) was four months. He recovered well, was back on his feet, and lived on for four more years. I remember that I also got irritated a few times when I felt he lacked the will to get well and that he was taking my care for granted. It took a lot of effort for me to change his mind-set. There were a few times when I wanted him to die and to leave me alone;in retrospect, I consider those moments a failure of my equanimity. What contributed to my impatience was that his own sons were unwilling to take care of him (they were busy in their respective professions) while I, a young man of 25, was made to be a nurse all day just because I had resigned from my job and wanted to spend time on my own.

I learnt a few things about death and dying on the way. No matter how much a person consciously wants to die, the body's main function is to ward off death. Discounting suicidal actions by the patient, the body will continue to remain alive even in apparently life-threatening conditions. There are reserves of energy in the body which get activated only in trauma or when close to death. And also, the person himself, once he/she loses control over his speech and actions, will plead for life and never for death. The body takes over the mind in extreme conditions. Even a person who has been through an attempted suicide will pray to the doctors to save him/her from pain and death.

The will of the patient to live can be quickly sapped by his care-givers if they get tired of him and want him to die. On the other hand, a depressed patient can be brought back to optimism by sustained and patient efforts of a care-giver.

The body becomes restless when death is at hand. One starts recollecting faint events and people far forgotten. One calls out to only those whom one trusts (or has loved in the past). One frequently starts hallucinating. After a threshold, bodily pain ceases to bother one. Unless a person has been deeply religious, religion and God is far from the mind of a dying person. Bitterness, unfulfilled desires and deeply held regrets come to the fore.

Life and death are the greatest of teachers, indeed. Other than the joy of learning and the desire to be happy, what more motivation is required to be a sincere student?


Anonymous said...

It will be really nice to read your thought on yoga and it's effects on body as a sequel to this article. You provide a very refreshing view on things. Thanks

Harmanjit Singh said...

Well, you can read what I have to say about Yoga on: