For the past year I have been faced with death each day as I step into the hospital. Patients enter the hospital, receive care by a staff of nurses, therapists and physicians in hopes they get better, and we send them home. However, sometimes that is not the case. As I stepped foot into the hospital on January 19, 2014 for my 12 hour shift in internal medicine I had no idea what lay ahead of me. After seeing my first patient, I heard over head “code blue room 556.” I walked precociously to the room to see an African American male in cardiac arrest. Nurses hurriedly got supplies ready and we started running a code. After 20 minutes of unsuccessful attempts of CPR with intermittent medication the patient was declared dead. I was asked by a nurse to explain to the patients wife what happened. As I gathered myself outside of his room on the fifth floor I heard a scream so chilling that made every person in the ICU stop in their tracks. The scream was so loud that people on the sixth floor could hear it. One scream was followed by another and then another and another. I walked outside of the ICU to the elevators to see the patients wife, collapsed on the floor screaming in pure shock and agony. Three nurses lifted her up, placed her on a chair and rolled her into the family waiting room. The nurses held her in their arms until she calmed down. I took her head in my hands and looked her in the eyes and said, “are you ready for me to tell you what happened to your husband?” she shook her head and said yes and I proceeded to tell her what happened. I asked her if she understood what I had explained and she nodded yes. She replied, “if only I stayed with him last night. I left after dinner but I should have stayed with him over night.” We assured her that what she did was appropriate and that she did exactly what she needed to do that night.

            I left the room to see the rest of my patients, walking around in a daze, still in shock after seeing her reaction but focused on my task at hand.  I finished seeing my patients and writing notes. I rounded with the attending in the afternoon and was assigned three more patients to see who had just been admitted from the ER. I go to the residents lounge, put in my orders for my patients and finish answering pages. Over head I hear, “code blue room 256.” I start walking down stairs, unsure of who this patient was but as I entered the room, and looked at the computer screen I realized it was one of my new patients from the ER who I did not have a chance to see yet. He was admitted for diffuse abdominal pain with unremarkable labs and a non specific CT scan. His vitals were stable when he got to the floor and he even walked to his bed. He was left alone in his room for 10 minutes and when the nurses returned to his room, he was found unresponsive on the floor. The code had already begun when I entered the room and I immediately got his next of kin on the phone. By the middle of my conversation with his next of kin the patient was declared dead. For completeness and medical records I still had to complete a history and physical exam on my deceased patient. After everyone left the room, I re-entered the room to see my patient with leads across his chest, a pale blue face and lying in complete stillness. I pulled out my stethoscope and listened for heart sounds and lung sounds which were absent. I opened his eyes to look for reactive pupils which were fixed and lifeless. I pushed on his soft abdomen and inspected his extremities.

            There was something so incredibly distinct about his body, lying on the bed, lifeless. You could describe the patient in medical terms but there was something more to be said. There was an additional element or innate quality missing from his body. That element was spirit. 

            In chapter two, verse 11 of the Gita, Krishna says to Arjun: “ You speak sincerely but your sorrow has no cause; the wise grieve neither for the living nor for the dead.”

            In Eknath Easwaran’s interpretation of this verse he states, “In the second line the Lord, in strong words, gives us the secret of our nature. Arjuna has been talking about death, saying that he does not want to be killed, that he does not want to kill, but Sri Krishna reminds him that it is only the body which is born and which dies. You and I were never born, nor will we ever die, because our real Self is not limited by our physical body. We are spirit, eternal, infinite, and immutable. This is the great discovery we make in the climax of meditation, that we are not the body, senses, mind or intellect, but supreme spirit. “

I finished my exam, exited the room and sat down in the nurses station to complete the history and physical exam, discharge summary and code note all in one sitting. I left the hospital emotionally and mentally exhausted. As I drove home, I called my mother to tell her what had happened that day, too tired to grieve or truly process what happened.

            As I returned to work the next day I thought to myself, many things in life come in 3’s. I had two patients code and they both died. Who would be the third code and the third death? Little did I realize it would be a week later, not in my own hospital but half way across the country in Houston.

            The day that I found out my amama passed, I was in the hospital. I was working in the stroke unit and had just admitted a patient. As I sat down at the nurses station to start my dictation I received the news from my mother. I immediately started crying. I could not hold back the tears but didn’t care as nurses, residents and patients saw my out pouring of emotion. I finished my note with tears in my eyes, quickly discussed the case with my senior resident and left the hospital. I went straight to the beach to watch the sunset. Even in my worst days, if I am able to see sun setting somehow I know that whatever problem or situation is presented to me, it will all be okay. Things have an uncanny way of somehow working out and the situations/problems/difficulties we face in life are here for a reason. With each step I took towards the setting sun and the edge of the ocean, I thought of my amama. Each step reminded me of her strength, her conviction, her willingness to speak her mind and her indescribable love for her family.  As I watched the sunset I am reminded of one of the underlying truths in the Gita: what has existed, continues to exist and will always exist.

            In chapter 2 Verse 17 of the Gita, Krishna says to Arjuna: “realize that which pervades the universe and is indestructible; no power can affect this unchanging, imperishable Reality.”

            Eknath Easwaran’s interpretation states, “Sri Krishna is driving into Arjuna’s consciousness the great truth that he is neither the perishable body, nor the changing senses, nor the unsteady mind, nor the wavering intellect, but the Atman, as immutable and infinite as Brahman itself. The lord of love tells Arjuna the nature of that which pervades the cosmos. All that we see in life is pervaded by the immortal, immutable, infinite Reality we call God.”

83 years, 6 months, 13 days.   How does one sum up that length of time in a span of a few minutes?   It’s an impossible task but we can try starting from the beginning.

Early Life

Born Visalaksi Draksharam on July 15th, 1930 in Chirala, India, she was the first child of Venkateswerlu & Kanakaratnam Draksharam.  She was the eldest of seven brothers and sisters including Bharati, Kamala, Prabhakar Rao, Rajeswari, Pandurang Rao, and Vydyanatham Babu,  As a child, she was described as bright, rambunctious, mischievous and bossy.  As you can see, not much has changed.   She was often found pulling pranks with her cousin Sarada, but somehow Visalaksi would never be the one caught.   But she wasn’t all trouble.  At age 6, she was on a train platform to leave for a prestigious boarding school, however upon seeing her mothers tears, she realized that she could not bear to leave home.  She was her mothers child at heart.

Beginning their own family

In May 2nd 1944, she married Hanumantharao Nisankarao in Chirala.  She was a fantastic cook and made the best biryani.  She enjoyed playing fiddle.  She graduated from Hindi Visharada and taught the language in a convent.  Also for a period of time she worked as a social worker for women’s welfare.  During this time, Visalaski and Hunumanthrao began their family.  At 16 she experienced her first heartbreak – a pregnancy which unfortunately was stillborn given the lack of appropriate medical care in that era.  However, at age 18, she gave birth to a healthy and beautiful baby girl - Ganulatha.  Then every two or three years, came Chandralatha, Sashikala, Savithri, Srinivas, and finally Venkatesh.  The family moved prior to Venkatesh’s birth to Guntur. 

At that time Visalakshi had to raise 6 children on a tight budget.  She was extremely resourceful, buying one bolt of fabric to stitch uniforms for all the children.  Visalakshi’s father also gave her a buffalo whose milk enriched these growing children’s bodies.  A young Savithri and Srinivas would not infrequently be seen steering this very ornery buffalo on a busy street for a vet appointment.  Her children fondly described their period of adolescence as a “reign of terror”.  Chandralata would often be found crying as she was not allowed to go to the movies.  All joking aside, Vishalaksi was a very progressive mother encouraging her children to do something that I believe defines our family – pursuing education.  As a result, Ganulatha was the first to attend and graduate from college and this was soon followed by her other children and culminating with Chandralata and Savithri graduating from medical school.  

Grandchildren

The 1970s & 1980s were the dawn of a new era– the era of grandchildren.  In 1971, Visalaski welcomed little Rajeev, followed later by Gopi in 1973.  The birth of these two boys marked a transition to a softer side.

I was born July 21st 1981, 6 days after my ammmams birthday.  My parents Savithri and Gangadhar made the difficult decision to leave me with my grandparents because they knew I would have a better upbringing in Hyderabad rather than Mancherial where they were working.  As such, I was raised until the age of 7 by my ammama and thattya. 

I have very fond memories of growing up in that three story white house in PS Nagar, Hyderabad.  I remember the laughter of my ammamma when I would come home from school with my nose wrinkled because the whole house smelled like the salty fish “uppa chappa”.  I remember learning how to count change in the front room with my tattya from their thriving restaurant business Vishal.  I remember Amamama’s secret bureau filled with snacks and chocolate reserved specially for guests that only she would have the keys to – a job she took as seriously as a prison guard.   I also remember she would spend hours scrubbing me from head to toe in sanagapindi in hopes that I would become a lighter shade of brown – that clearly didn’t work.

I have one particular story that my Ammamma would share with me often and in fact did the last time I saw her thanksgiving.  One of my grandmothers most prized possessions was the spectacular pair of diamond earings that she always wore and is wearing today. Apparently as a baby, I would always reach for her ears, largely because these diamond earings were massive and to me appeared to be stars that I thought I could touch.  She seemed to be very amused by this and at a young age promised that I would inherit them from her upon her death. 

One particular day, I must have been about 4 or 5 years old,  I had gotten into some trouble which in all likelihood was probably due to my cousin Sanjeev but I always was the one caught while he got away scot-free.  Whatever it was must have been a fairly serious offense because the punishment was harsher than usual.  She told me that through a torrent of tears, I looked up at her and asked her cruelly “When am I going to get those earings? When are you going to die?”  To which, she laughed, pulled me close to her and replied “Never”.  Turns out never was approximately 28 years later.

Overall

My ammama was an extraordinary person. She was a ship that held steady no matter what waves crashed upon her.  She had several trying times including the death of her children Sashikala and Venkatesh.  But she faced them as she faced every adversity – head on and with pure strength.  She was a formidable opponent to life.  In our family, she was the matriarch.  What to her children early on may have seemed like ruling with an iron fist was in fact the strength and determination that shaped them into who they are today. 

When I look at the women in my family, especially my mother Savithri, and my aunts Ganu and Chandra and Anu, I see my grandmother in them.  Each of these women have had difficult times but they like my Ammamma braved the storm with ferocity and are the stronger for it. 

My generation including Rajeev, Gopi, Sanjeev, Kranthi, Savitha, Vasu Sashi and Krishna also have inherited something unique from our grandmother.  I believe that she gave us the drive and determination to pursue our dreams.  She is the reason why so many of us are doctors, dentists, lawyers, engineers, or businessmen and women.  Visalaksi’s high regard for education and the many sacrifices she and her children – our parents – have made, is the only reason my generation have been so successful.  And we will forever be in their debt.  I am sure that her great grandchildren Aakash and Arjun will follow in these footsteps.

Tattya

While our grandmother has infused her vitality into her children and her grandchildren, I would be remiss if I didn’t discuss where she obtained this seemingly herculaean strength from.  It was from her husband and my grandfather Humumanthrao.  My grandfather is the kindest, gentlest man you will ever meet and at first glance may appear to be the polar opposite of my grandmother.  When their children were young and were scolded harshly by Vishlaksi, it was Hunumanthrao that would often go to console them and wipe their tears away.  He seemed to have an endless supply of smiles and never an unkind word to say.  I believe that the men in our family especially Srinivas and the late Venkatesh took after their father in that respect and are gentle, kind and loving human beings that dont know how to say no and give everything they have to make your day a little bit brighter.  My grandfather was the silent but powerful hands that supported my grandmother.  Without him, I do not think she would be who she was.  They would have been together 70 years this May.  And I believe that it was destiny that she would pass on his birthday.

The End of her life

Being a physician, the end of someones life is something that I have often been blessed to be a part of.  I believe that everyone has a right to leave this world with dignity.  I too often see patients artificially supported while their family fights over their last moments.  So to this end, I am so very happy with how Ammamma left his world. 

Her last day was one of her best days.  She awoke in her own bed with her husband beside her. She showered; she had her morning coffee.  She called her children and chatted with them about the little things in life.  For lunch she ate one of her favorite meals - peanut butter and jelly sandwiches. She wished her husband a happy 88th birthday.  She then went to her bedroom to take her afternoon nap and now – she continues to sleep.  She went quietly and peacefully in her own bed, with her husband of 69 years closeby.  It is hard to imagine a more perfect and gentle way to leave this life behind.

83 years, 6 months, 13 days.   That is a long time to live and to love.  So while we have every right to mourn Visalaski, let us also spend this time celebrating her extraordinary life and the way she has touched each of us.

Ammama – we love you and miss you very much but don’t worry – we will see you soon in our next life.