Dr P Ravi Shankar
Xavier University School of Medicine , Oranjestad, Aruba
The room was simple. A wooden bed on one side, a sofa for visitors on the other. Two unadorned wooden doors faced each other, allowing some cross ventilation. Both opened into long dark and cool corridors as was common in old houses in Kerala. I had often enquired as to why houses were built in this manner and my elders answered that it was to store the paddy harvest. Kerala (a state in South India) was once a major rice producer, though urbanization and increasing wages and living standards have resulted in a big shift towards 'cash crops'. Photos of Hindu Gods, Goddesses and saints were arranged on one wall. Reflecting the family's agricultural heritage, sheaves of paddy were stuck above the door frame using a big dab of red clay. Traditional Kerala houses had a wooden step at the bottom of the door which you have to step over to enter the room. I used to trip over the steps and hit the floor with frightening regularity. A table top valve radio, veneered in rich brown wood, occupied pride of place in the room. My grandmother made it a point of listening to the news and devotional music on that radio every evening. In the nineteen seventies and eighties television broadcasts had not started in rural Kerala and the radio was still highly popular. When I was small I was fascinated by the big radio, particularly the large white knobs used for tuning into medium and short wave radio stations.
My mother often remarked that grandma had always been a religious lady and liked to visit holy places on pilgrimage. She was not very interested in house work and the nitty-gritty of running a house, so many of these responsibilities fell to my mother when she was relatively young. Towards the last decade of her life my grandmother had begun to suffer from difficulty in movement and resting tremor, which progressively worsened. Eventually she could hardly manage to carry out any of the daily activities on her own. She was living with my uncle and aunt in an old house built by my grandfather in the 1950s. Like in many traditional Asian homes, the toilet was in the back of the compound near the cowshed. In the 1970s this was a hole in the ground with palm frond walls for privacy before a more permanent structure was constructed.
Every evening my grandmother used to read the Bhagavad Gita and other Hindu religious books in a loud singsong manner. When my cousins and I were young she used to tell us stories from the old Hindu epics. As her illness became more severe, her reading and other activities declined. In the early days she walked around the huge house unaided. We visited Kerala in the summer vacation every two years. During each visit I was saddened to watch my grandmother slowly deteriorate. She was only able to shuffle around the house with a forward stoop. Her tremor became worse. She was no longer able to drink water from a cup or glass and someone had to help her. Soon she could walk only for short distances with support. Eventually she could only potter around the sick room. Her speech began to slur and become indistinct. I began to have difficulty understanding what she was saying and my aunt or my uncle had to interpret her words.
In those days there was no doctor in the village. There was a doctor who used to practice during my childhood days but he had moved away. There were doctors and a government hospital in a small town about 10 km away. However my grandmother had never seen a doctor. After attending medical school I began to think she may have been suffering from Parkinson's disease, a difficult disease to deal with that grows progressively worse. Even with treatment the problems of the on-off phenomenon, end of dose deterioration, and abnormal movements became common. Perhaps with proper treatment my grandmother might have lived a decade longer and had a better quality of life.
I am somewhat surprised that no medical treatment was provided to my grandmother. We were a modern progressive family in many ways. Most of us were educated and many were living in the big megalopolis of Mumbai. My grandmother was suspicious of western allopathic medicine and had always preferred herbal remedies and Ayurveda (the traditional Indian system of medicine). I feel none of her sons took the initiative to get her treated. Though she was shown love and affection no one got a doctor to visit and examine her and try to understand what exactly she was suffering from.
Towards the beginning of the nineteen eighties she was completely confined to bed and dependent on others for everything. The room was cool but did not have much light. Old houses are dark and ill-lit. Modern picture windows letting in plenty of sunlight were still uncommon. Green hills were visible in the distance. When it rained heavily a cool breeze laden with the scent of distant forests and emerald green paddy fields wafted in. The voltage was poor in those days in remote villages and the flickering light bulb cast a dim glow over the room.
My grandmother passed away during the summer term break in the 1980s. I still remember how devastated my mother was on hearing the news. The great Indian summer travel rush was on and train tickets could not be obtained for love or money. Today with economic growth the Indian middle class has the option to fly, which was not available three decades ago. With great difficulty my mother and uncles could obtain train tickets about four days after my grandmother passed away. By the time they reached Kerala after a thirty-six hour journey all the death ceremonies had been completed. I was sorry to have missed my grandmother's funeral. She was a sweet lady who did not concern herself much with the mundane affairs of the everyday world. This was in stark contrast to my paternal grandmother, who had taken charge of her family affairs at a very young age after her husband passed away. I miss those days when I was young and the future was pregnant with endless possibilities!
Dr P Ravi Shankar is Professor of Pharmacology at the Xavier University School of Medicine, Aruba, Kingdom of the Netherlands. He is Chair of the Institutional Review Board and the Curriculum Committee, and facilitates a medical humanities module at the institution. His areas of research are medical education, pharmacoepidemiology, and pharmaceutical care.