Distance

Mallika Sekhar

April 2020
The ward doctor rang me late in the night to say that the Judge had been admitted with COVID-19 and was not doing well. He wasn’t deemed fit for ICU because of his age and his prior illness, the blood cancer for which my team had been treating him for many years.

I thought about the Honorable Judge much of that night. Judge Sessions was what I called out to the crowd of patients in the waiting room, and it was how I addressed him during our consultations. To most of the staff he was plain John, or Mr. Sessions, but I am partial to the professional address, possibly from my Indian penchant for deference. His numerous letters to us, handwritten in fountain pen on smart, textured, A5 paper, were marked with his name and honorific, leaving no doubt in my mind or in his that he was indeed Judge Sessions.

Dapper, solemn, and meticulous, he was courteous even as he disagreed with you, bringing judicial clarity to our discussions. Over the decade, we moved through treatments, chopping and changing to get his symptoms and blood numbers just so. He never lost patience, tolerating errors and delays. His questions were specific and clear, requiring a response even when they were a nuisance. In slanted handwriting, he asked whether we might wish to adjust the dose of this or that medicine or whether we really meant the new doses that someone else in the team had telephoned him about. Yes, we would reassure.

A year ago, he lost weight and became worried. “Could this mean cancer?” he asked.

“You mean, another cancer?” I replied gently. “You already have one cancer.” The longer one lives with a chronic malignancy of the marrow, the more surprising when it is pointed out that the C-word applies—as though cancer gets diluted out with the passage of time. I explained to him that his marrow was making a category shift for the worse. We changed treatment and his health gradually improved.

I was pleased that he had a straightforward relationship with all of my team, making no irrational demands for a particular physician to attend to him. But I was secretly resentful, sometimes jealous, when someone else randomly picked his chart to see him in the outpatient clinic. Over the past year he was seen by a succession of colleagues; that’s the way it works in the National Health Service of England—no individual joy of meeting a favorite patient, but equity for all.

After that late-night call from the hospital, I lay under a diffracted canopy of stars listening to the unceasing sounds of ambulance sirens. I thought of this remarkable man who I was sure would still be his usual scrutinizing self behind the oxygen mask. I would go to say hello to him the following morning; I would not abandon him. I emailed for permission to enter the Covid ward.

As I started my regular rounds in the morning, my resident informed me that he had died during the night, less than 24 hours after admission. I hadn’t even received a reply to my request.

With such swift deaths, there is no time to answer nonessential emails, no time to hang in there for someone you know to turn up, to seek the reassurance of a familiar face. The tragedy of families barred from the wards of dying patients is immense, but the passing away of a long-time patient without a chance to say goodbye has a sadness of its own. The Judge was, in the memory of all my colleagues, ‘a character’ and we were all sad to have lost him to COVID-19. One must go sometime, but he hadn’t, in our reckoning, gotten to that point.

For many days after, I thought of dialing the Judge’s number to offer his family my condolences. Sometimes I even started dialing, only to disconnect. Not today, it’s too soon. Not today, it’s too late. I wondered when the last time was that I was so moved by a death to feel so uncertain of my responses. I dismissed the thought of attending the Judge’s funeral; Covid funerals were restrictive and groupings were disallowed. And anyway, how could I know what his family thought of us, his doctors, in the events leading up to his death?

April 2021

I was thinking that I should buy a card to send to the Judge’s family on his anniversary. My flight home had just been cancelled; India was now on a red list due to rising Covid cases. My parents told me not to worry, that I could reschedule my trip for June. I talked about my work and my father said to me, “What you are doing is important. Keep at it.” There was a certainty in his voice.

I’ve lived for just over half my life in London, but never felt as removed from India as I did then. It was not just that my flights to India had been cancelled many times. It was that none of my experiences mirrored those of my friends or family in India. Their incomes plummeted, or worse, ceased. Hospitals closed their doors. Those facilities that did accept the infected and the ill ran out of their reserves of oxygen.

Two weeks later I sat at my kitchen table instructing my brother AJ, in Chennai, on how to adjust an oxygen concentrator. I am medical but not technical; he is neither, his income precarious. But he was wonderfully calm, and we fixed the flow rate. Our father’s oxygen level came up from a heart-sinking 72 to 92.

Earlier that morning I’d woken up with a start to the shrill notes of the land line; apparently I’d slept through at least five WhatsApp calls. My father’s Covid symptoms had worsened sharply in the past 24 hours. My mother’s oxygen levels were hovering at 88. For three days we had been in pursuit of oxygen. They were quarantined in separate rooms in their third-floor flat—she in the bedroom, he in the living room. They could see each other through a barred glass window which connected her bedroom balcony to the living room. They watched the cricket matches on TV together. As if by miracle a concentrator arrived that Thursday morning. My mother was more stable, so we put the oxygen up for my father. I made frantic calls to colleagues for advice on optimizing the concentrator.

For a few hours my father held his own. But by nightfall an ambulance was called. AJ stayed home with our mother while my other brother, Babur, escorted my father. I saw my mother on WhatsApp, standing behind the barred windows watching my father leave. They’d been apart for ten days. As my father was hoisted into the ambulance, I imagined that he was comforted by knowing that mother was on the mend.

For the next three days, my father and Babur were lost to us. Babur did not use social media on principle, and my father had never bothered with mobiles. Once, my mother had convinced him to pose for a selfie, but that was about it.

For those three days, my thoughts were in ferment. The oxygen concentrator—I could have done it differently. Better. “Your father is orphaned,” my mother said, with her trademark bluntness.

“He is being looked after by people like me,” I told her. My words fell unheard.

On the one occasion that I got through to Babur, he was incoherent with despair. He relayed the day’s numbers to me: 20, 300, 30%. Blood tests? Cardiac function? He couldn’t clarify what this update from the doctor meant, but I could tell that it was dire.

Babur stayed at a motel by the hospital, but I don’t think he slept. When he suddenly got news that our father was to be intubated, he raced to sign the do-not-resuscitate form; Father had been explicit about that. I imagined Babur running through the midday mirage of the incandescent road, T-shirt soaked with sweat. I could see him grasping the hospital’s Covid-proofed ballpoint, concentrating on that signature, blinking away the salt in his eyes.

Three days after leaving home, my father died amongst strangers.

We couldn’t complain, really. My parents, in their eighties, had been Covid-diligent and due their second dose of the vaccine the week that Covid struck. Compared to the rest of India, we managed to obtain home oxygen, an ambulance with competent professionals, a hospital bed with oxygen supply. I, from my kitchen in London, could supervise my parents’ home treatment which my brother could administer.

My mother told me that the mortuary staff were gracious and kind. Incinerators had broken down in the heat of May, and a central dashboard directed clientele to changed destinations. The staff at the ‘icehouse crematorium’ were compassionate in the middle of the baking heat. They helped families conclude last rites—brief and rushed, but at least something. Father was number four in the queue. The crematorium staff hadn’t been paid in weeks.

After my father’s death, my mother was apprehensive about sleeping alone. She told me that Banu, our daily help, would stay with her some nights. Banu delivered milk to the neighborhood at dawn and cleaned dishes at a dozen homes. She had a milk-cart attached to a bicycle and worked late into the night. “How will you manage this, Banu?” I asked her on WhatsApp. “And how would the payments work?”

“It’s anpu,” she said, using a Tamil word for love. “I don’t want money for it.” Her words were unexpected and overwhelmed me. Of the many types of love, anpu is one that is expressed but not spoken of. And for her to spell it out to me: I felt crass. It then struck me that this emotion described what people gave and received through the pandemic. Both my father and the Judge were isolated from their families—orphaned, as my mother would say. But they received love from strangers—their doctors, nurses, funeral staff. I take solace in the fact that my family received that anpu and I can offer that same love to my patients, who come to me as strangers.

Death of a parent is the diaspora’s lurking menace. The call, the rushed exit from work, the first flight back. The omniscient fear of uselessness at time of need, of not being on time to help, to grieve, to mourn.

It is the expatriate’s lot to be distanced and I had expected no different. But the deep anguish remains. This pandemic has mutated the notion of distance. Every family has been burdened with separation, with permanently incomplete narratives. For me, the need for the physical is overwhelming. My void is not just my father’s absence, nor even the inability to feel my mother’s touch. It is a fragmented void of dislocation—my family’s, my patients’, my own. We all feel orphaned.

Although the Judge’s death preceded my father’s by a year, in my mind, their deaths are meshed together. Even though the time for sending a card to the Judge’s family is long gone, I still think of him. I doubt that he would have used the word “orphaned.” I expect he would have been true to his pragmatic self all the way to the solitary end. Even with the distance between him and his family, the distance between him and the PPE’ed medical teams, I can imagine him examining and perhaps recognizing the love. I only hope that he was able to allow it in, to feel comforted by it that night of the ambulances and sirens.