Part I: It is a matter of the heart

The BP monitor reads 80/60. I know it is low.

‘His Sugar is high.’ The Emergency doctor tells me.

‘How high?’

‘It is Hi… Glucometer can’t measure it… beyond 600 it must be… Does he take medicines for Sugar?’

‘Yes. He has been… regularly for many years.’ I tell her, unsure of my answer.

I go near Father who now has a NIV mask clasped around his face. ‘Why is your Sugar so high? Are you not taking medicines?’ He looks at me sheepishly, signalling that he has been.

‘Lactates are also high.’ The nurses are telling the doctor.

Google informs me that high lactates or buildup of lactic acid in the bloodstream can be due to oxygen not reaching the tissues, which can be due to pulmonary or circulatory disorders or cardiogenic shocks.

They put him on insulin and Norad to increase and stabilize his blood pressure. Google tells me that

Norad – noradrenaline or norepinephrine is a neurotransmitter which is released by the brain as part of a fight or flight response in response to high stress. Besides increasing alertness, on reaching the heart, Norad commands it to pump harder to deliver more oxygenated blood to the rest of the body resulting in increased blood pressure. As a medicine, it is administered to increase and maintain blood pressure in certain situations like cardiac arrest.

The BP monitor reads 88/62.

A guy in a black suit and tie asks me to join him outside at the reception. Why is he wearing a suit inside a hospital at six in the morning? A girl at the reception types into a computer. She gives me a form to fill in the details and asks me to make a refundable deposit of 15,000 rupees. ‘Sir, it will be adjusted at the time of discharge.’ Thanks for explaining to me the meaning of refundable deposit.

A new doctor arrives in the emergency to look at Father. ‘How are you feeling now?’ My father nods that he is feeling fine. ‘What happened to you?’ Father removes the mask and tells him that he felt breathlessness and weakness.

He then asks me what medicines does he take. I tell him, for sugar and cholesterol. That he has a history of cough and bronchitis. That he underwent some treatment for an infection a month ago when he experienced severe cough and weakness. Could be another infection this time, is it?

‘Could be. Could be something else. He needs to be admitted in the ICU…’

‘Why ICU? Is that necessary?’ I think of the news reels Maa sends me regarding hospital scams for looting money and killing patients in ICU.

‘Yes. His BP is low, sugar is very high, is having difficulty in breathing… We don’t know the cause yet. It could be an infection or something else. We have to see. We have sent the blood samples for tests. A CT scan will be done. But he is… very sick.’ He stresses on the very sick. ‘Will need special care.’

The guy in the suit appears again. Again, the girl at the reception types into her system. Another deposit. 65,000 rupees. ‘Sir, it will be adjusted against the final bill.’

They strip Father of his T-shirt, trouser, underwear and slip a light pink robe over him. He lies on the bed with his head slightly raised and the NIV mask clasped around his face. They ask me to wait outside. I sit at the reception, holding his clothes, belt, wallet and shoes. 6.30 AM. It’s a Thursday morning. 45 minutes since I brought Father in an ambulance to the emergency ward. Two hours since he lay on the floor of our living room, unable to breathe, unable to stand.

Never before I had been in an ambulance with its siren blaring. I had never been in an emergency ward before. I had never known what is to be done when someone is sick and needs to be admitted into a hospital as an emergency. I had never known what am I supposed to do if Father is very sick. But I had managed the initial steps well. It was a capable, calm and restrained performance.

**************

11.30 AM. Father is now in MICU – Medical Intensive Care Unit. He still has the NIV. Besides Norad and Insulin, he is now also on Lasix. Two new doctors.

‘Trop is high.’

‘Achcha! How much?’  ‘0.9.’  

What does that mean, Trop is 0.9? I can’t google as I had to leave the phone outside. To prevent me from making recordings and taking photos and post on social media.

They ask me his medical history. Sugar and cholesterol medicines, I tell them. For how long? Sugar medicine for 10 years, cholesterol for probably 7-8 years. I go near Father to confirm. He says 20 years. I tell the doctor – 20 years. In his file he had already noted 7-8 years. I tell him to correct that to 20 years.  I wonder if that makes me look like an ignorant, careless son?

The main doctor arrives. The lead actor. Dr B. I understand he is the lead actor because he has grey hair and everyone including these two doctors, the second doctor from the emergency ward earlier in the morning, a group of people who clearly look like doing their residency, now surround him.

They inform him of the situation and protocols followed so far.

‘Sir, Trop is high.’ Wtf is this trop? ‘Sugar is high. 500+.’ Dr B reviews the reports which have now arrived. 7.26 AM. The time stamp on the reports. They all murmur within themselves. ‘What is the Lasix dose? Hmm… Ok… ‘

After a few minutes of gibberish murmurs, Dr B turns towards me. ‘The way we see it, it is a case of a heart attack.’ He says it in a low, matter-of-fact tone.

‘How do you say that?’ I feel the stress rising in my head now.

He shows me the reports. ‘These tests are like markers of a heart attack. These values are all high’.

Troponin I is 0.977 ng/mL. Trop is 0.9! Normal range for a male is < 0.6.

Creatinine Kinase MB Mass is 51 U/L. Reference interval < 25 U/L. The interpretation written below says elevated levels indicate acute myocardial infarction. Medical jargon for heart attack.

NT-proBNP is 6751 pg/mL. Reference interval < 125.

‘These are some proteins and enzymes that are released into blood when there is a heart failure.’

‘But the ECG report looks normal, right?’ I say while scanning the sine curves on the red grid sheet without knowing what a normal ECG looks like.

‘No… the ECG is also indicating that.’ I read and memorize the words Sinus tachycardia, right ventricular hypertrophy, acute infarct written on the ECG, to check with Google later.

‘And there is this HFrEF which is around 25%. We basically put the results in a formula and it tells us at what capacity the heart is functioning. His heart is basically functioning at only 25%. A normal heart functions at around 50-70%.’

I look at Father who cannot hear the conversation but looks at me trying to gauge the seriousness of it. Your heart is functioning at 25%.

But that is not how they show heart attack in the movies. There the heart attack is accompanied by severe chest pain. Old, senile fathers angry with their daughters marrying guys not approved by them, hold on to their chest displaying emotion of pain before falling down the stairs. Father didn’t exhibit all that. He was just finding it difficult to breathe. No chest pain. No pain in the arms.

‘Also, his lungs are filled with water which needs to be removed. It happens when the heart is weak. It pumps back water into the lungs.’

‘We will do an angiography. So, we will have to get the water out as much as possible as he will have to lie down for that. We are increasing the Lasix dose to get the water out.’

So that is what Lasix is for. To remove excess fluids from the lungs.

‘Do you have insurance?’ Dr B asks me.

‘I do.’

‘Is it a corporate one?’

‘Yes.’

‘Okay. Please wait for a while. We will call you.’

I inform Maa about the new developments. She warns me about how the hospital would want to do all sorts of procedures. Don’t listen to them. That is their modus operandi to rob gullible people like us. I ask her to come and speak to the doctor as I am way too gullible. She understands medical science better than me. She would have liked to be a doctor if she had been supported. Her grandmother was a competent nurse. She is also more aware as she watches more reels than me.

‘HFrEF at 25% means Heart Failure with Reduced Ejection Fraction, where the left ventricular ejection fraction (LVEF) is 25%. EF or Ejection Fraction is the percentage of blood the left ventricle pumps out with each heartbeat. A normal value is around 55 – 70%. A value of 25% means severe systolic dysfunction associated with shortness of breath, fluid retention etc.’

ChatGPT informs me. With each beat, Father’s heart is only able to pump out 25% of the blood to the rest of his body.

**************

‘So you see this… there is over 90% blockage here in the proximal and here in the distal portion.’ Dr B explains as he shows Father’s angiogram to us. ‘This is the Left Anterior Descending artery, the largest and main artery. This is like the lifeline of the heart.’

‘Also, the left circumflex here is fully blocked. And here this right circumflex has 50% blockage.’

For reference, they show us a healthy heart’s angiogram.

‘But how is that possible? He has never been sick or has had any heart issues before.’

‘How is he functioning so well with all these blockages?’

‘He has diabetes, right?’ ‘You must have heard that diabetes is a silent killer. You often get to know only in the end in many cases.’

Silent killer.

‘He is very critical. We need do an angioplasty without delay.’

Maa looks at me for my opinion. I tell her that as two gullible people, we have no option other than to agree.

4 PM. Father is taken to Cath lab. On his way, he asks Maa if they are going to cut him open. Maa assures him to not worry. It is a simple procedure. Maa has been through three surgeries. It is a first time for Father. So he is scared. He says that after what happened today, he won’t worry about anything.

5.30 PM. Post angioplasty, a young doctor tells us that they have inserted three stents – two in LAD and one in the left circumflex. Promus Premier brand – German made. ‘They are the best.’ He shows us the new angiogram with the two arteries now opened up.

We meet Father in the Cardiac Care Unit. His bed number is 16.  There were 15 other beds in the room. 15 other lives monitored by and dependent on assortments of BP monitors, injection pumps, IV bags, ventilators, urine bags, bed pans.

There were no windows in the room. I hate rooms with no windows. I also fear if one day I will end up like this.

Father’s BP is now 110/80. Better than 80/60. He is feeling okay. Tired but okay. I tell him about the three German made stents inside him now. That he we will be home by Saturday or max Sunday.  I don’t like the sight of him lying in bed with all the catheters and tubes inserted into his hands and neck. I caress his head, his face. He likes it. Gives a tired smile.

6.30 PM. More than 12 hours since he lay helplessly on the floor of our living room, unable to breathe, unable to stand.

***************

Next morning he looks better. BP is 110. Heart rate 92. I check the injection pumps. Norad, Lasix, Insulin. Sugar is 260. Better than 430 as measured earlier at 6 AM. He is not using the NIV. The nurse apparently suggested that he should try to breathe normally once in a while to not depend on the NIV. He tells me he was served idli and dalia for breakfast which he didn’t like and felt like puking. I couldn’t agree more. Who eats dalia for breakfast, that too cooked in a hospital kitchen. Father and I would rather stay hungry. He wanted to have tea. Homemade tea.

I scold him for all the beers and mutton curries he could have avoided to not end up like this.

‘But then I would not have been able to enjoy all those beers. Most people don’t enjoy life because of living in fear.’ Duh! Imparting life lessons now.

There is a new doctor around. Dr M. Young, Bengali and a sweet talker. He speaks to us in Bangla like how Bengalis do when they come across other Bengalis assuming it will be more comforting for us to hear everything in our own language instead of English or Hindi. He explains to us the current situation through a persuasive Bengali performance. That there is good progress. We are trying to get the water out of his lungs for his breathing to be easier.

I despise him. Because I despise sweet talkers. Who show excessive concern for no apparent reason. Who in their ingratiating tone can’t stop saying how they can imagine our pain, what we are going through.  Or maybe he is genuinely concerned and I am just arrogant. We sign the patient consultation sheet for today. Everything has been explained to us properly. So that we do not take them to court if anything goes wrong later.

In the evening, Father again looks tired. He is using the NIV. Tears appear near the corners of his eyes with the strain of breathing. I caress his head, his face. He likes it. Everything will be okay. It has to be.

I get hold of Dr B. ‘Why is his condition not improving with the arteries opened up now?’

‘It takes time. The heart is weak. It is learning to slowly get up and walk again before it starts running.’ Dr B in his matter-of-fact, composed performative style.

‘You brought him in time and the procedure was done. Otherwise, we could have lost him. The main artery we showed you, the LAD, was blocked. In our parlance, we call it the widow maker. So… there is progress but it will take some time.’

We call it the widow maker.

***************

Father doesn’t look good at all next morning. Maa is furious and gives a soft scolding to the entire medical team. ‘Why is the NIV not being used? Can’t you all see he is unable to breathe? Why is his condition not improving?’ I maintain my sophisticated, calm demeanour. The nurse says he is not eating much so the medicines are not working. Of course! Why would he eat that dalia? I look at Father who is looking at the crowd around him with tired eyes. Probably wondering that no one will be spared of his wife’s wrath today.

Someone says that very little urine is being passed. I see the urine bag hanging by the bed. I see the log sheet. 850 mL urine passed previous day. Dr M had told us that figure needs to be 2 – 3 litres daily for his lungs to be free of water.  

Dr B asks the team to increase the Lasix dose to increase fluid removal. Put on the NIV. Yes! Use the NIV when it is right there. We are paying for it so use it! ‘And put a Ryle’s tube also.’

Dr B takes us aside. ‘Lot of water in the lungs. Kidney function is poor so not much urine is passing. So we will be consulting a nephrologist today.

‘There is no danger, right?’ Maa asks innocently.

‘There is danger. But we are working on it.’  

At some point today… or yesterday… on the ground floor corridor, I was horrified to see an old woman with a tube attached to her nose, not knowing what it is for. In the evening, I see a tube inserted into Father’s nose. Ryle’s tube. That is the price you pay when you don’t like dalia. They are feeding him Ensure Diabetes Care. 1 scoop with 60 mL water every two hours. I had brought one packet for him several months back for strength and nutrition. He never had it as he didn’t like the taste. Now he had no choice. It was being fed to him through a tube inserted in his nose. I ask him if the tube is hurting. He nods in negative. How could it not. He is lying.

**************

‘Is it day or night?’

Father asks me when I visit him next day. It had been four days he hadn’t seen the transition of light into darkness and back. A perpetual LED glow kept him in the dark. He wasn’t aware of the time as the only clock in the room was in the far corner in opposite end of the room. And he hadn’t got down from his bed as he couldn’t sit up yet with all that water in his lungs.

‘Find out how much does this cost.’ He says pointing towards the ventilator. I know what he is thinking. Let’s buy this ventilator. I will then checkout from here and use it at home. He is imagining me putting the NIV mask around him and him doing breathwork every one hour. He seriously means it. So I memorize the brand name. Getinge Servo C. Later at night, internet shows me a quote for 12 lakh rupees. I am sure Father will ask me to look at other cheaper brands.

On the way home, I get a call. From the hospital billing department.

‘Sir, we haven’t got payment approval from your TPA. Please speak to them otherwise you will have to pay the whole amount which would be higher if you pay directly.’

‘And why is that?’

‘Sir, with TPAs, rates are revised every three years. For direct payment, rates are revised annually.’

‘Okay!’ I don’t care whatever scam you are explaining! ‘I will check with them.’

The TPA person tells me that there is a mistake in Father’s date of birth. They have sent it for correction to the insurance provider. Once done, they will send the payment approval. It will take a day.

Yeah! Get it sorted.

**************

He is sitting upright this evening. He still has the NIV but is in an excitable mood. It seems the medicines are working. He wants to have a piece of the orange I brought for him in the morning. He asks me to force one piece through his mask into his mouth before anyone sees. I fail to do that as the mask is tight. He scoffs at my incompetency. He takes it himself and forces it through his mask into his mouth. I ask him to spit out the chewed pulp which I throw into the bin. With a hyper expression, he asks me to get a pen and paper. I borrow from the nurses at the reception and give it to him.

He scribbles his foggy thoughts. I want to leave by day after tomorrow. Continue treatment elsewhere in smaller hospital. Apply today to remove my food pipe. And other stupid stuff.

I roll my eyes and reprimand him about not trying to be his own doctor. There is water in your lungs. Your kidney is not functioning well. You can’t just check out yet. He tells me to go home and discuss with Maa and take decision.

He says other stupid things which I do not agree with for which he calls me stupid. ‘Okay! Now go home. We have done all the talking for today!’ I caress his face, his hair and he nods in pleasure. On the way home, I inform Maa about Father’s super charged behaviour and thoughts. She did not visit today as she is not feeling well. She is confused but agrees that we can’t just check him out in that condition.

*****************

12.24 AM. My phone rings.

Half asleep, I hear someone say, ‘Come now. Doctor needs to speak to you.’

I feel my body being weighed down by a giant boulder. It’s a cold December night. I reach around 1.15 AM. Running… walking fast… through the corridors on my trembling knees. The security guard stops me at the entry to CCU. Then checks on the wireless and lets me go.

Father is lying on his bed. Sleeping. A plastic tube now inserted in his open mouth. A blue cloth cap over his head. BP 66/40. There is a new doctor. He calls himself the ICU doctor.

‘He had a VT rhythm episode.’

‘It is an abnormal condition where the heart starts beating very rapidly and goes into arrest. So we had to do an emergency invasive ventilation to save him after CPR.’

‘Why did it happen?’

‘It is an abnormality which can happen to anyone, anytime. The heart starts beating very rapidly unlike a normal rhythm and goes out of sync.’

‘But he was fine in the evening. He was sitting upright and spoke normally.’ I question him.

‘Yes. He was okay. He also asked for coffee. Then around 12, this happened.’

‘But why did it happen when he was fine?’

‘Sir, that is what I am telling you. That it is an abnormality that can happen anytime, particularly when the heart is weak.’

I stand next to Father’s bed. Not sleeping. Sedated. His mouth open with a plastic tube inside him. I caress his head, his face. I massage his left arm. I feel the tears on my face. I am aware of the ICU doctor and nurse watching the sad scene.

‘Sir, if you can sign this consent form. We would need to tie his hands, so that he doesn’t try to bring the tube out of his mouth under sedation. It can cause injury.’

You want me to give you consent to tie his arms? In which he carried around six- or seven-year-old me during Durga Puja pandal hopping when I didn’t want to walk. Arm with which he held my hand to help me cross the busy flyover while returning from school. Arms with which he would just randomly hug me when I would be brooding. Ki eto bhabte thakis tui?

‘I am not signing anything. Do what you have to do.’

They tie both his hands to the two sides of the bed. They ask me to wait outside.

I don’t sit in the lobby downstairs. The handful of people loitering around and the guards will see me. They can’t see me. So I go out of the hospital. There is a park next to it. I go inside. Its 3 AM. Dark and cold. I am shivering violently in my sweatshirt with my knees crumbling down. I wail out loud. I perform for the forces of the universe. For every God I have ever prayed to only in self-interest. I ask them to not punish me for not knowing what I want in life. For not being able to come out of the prison of my desires and illusions. For not appreciating the so-called gift of life. For not having gratitude for what I have and only worrying about what I don’t. For drifting through my adult life, lost and fearful. For not having the courage to act on anything. I beg the night to not make my worst fears come true. I feel myself very small and collapsing under the weight of the cold night.

Maa cries on the phone telling me to go inside and not stay out in the cold. ‘Tor kichu hole aami ki korbo?’  We go on crying and discussing VT rhythm, that he has a tube inside his mouth, that his hands are tied to the bed.

VT rhythm – Ventricular Tachycardia,

occurs when abnormal electrical activity leads to the ventricles start beating very fast at 120-250 bpm, independent of normal rhythm. It can occur suddenly; very little blood is pumped out; blood pressure drops and patient may pass out or go into cardiac arrest.

Those with previous heart attack or LVEF < 35% or coronary artery disease have high chance of abnormal electrical circuits developing in the heart.

ChatGPT informs me of the last part based on my chat history.

******************

‘Ma’am, this can actually happen to anybody, anytime. It can happen to you and me also.’ A new ugly doctor tells Maa a few hours later when she comes to see Father. Then why doesn’t it happen to you right now. Why doesn’t your electrical circuit go haywire?

Troponin is 48.35. Five days ago, it was 0.97 indicating a heart attack.

Renal profile shows Urea at 135 mg/dl (normal max – 43) and Creatinine at 3.35 mg/dl (normal max – 1.3). Indicating acute kidney failure.

Dr M is energized and suggests Dr B and others to test for catecholamines. ‘Could be an infection.’

‘I can understand your fears. That you fear if he will come back from this condition.’  He doesn’t fail to express his grave concern for our situation. ‘But it’s not as bad as it looks. Please be patient. People come back from this. Aamra ektu ektu kore aage baarchi.’

‘As no urine is passing, we will have to do a dialysis to remove the fluids. For that his BP has to be increased first for which we are increasing the dose. Norad. Higher dose. Meanwhile I would ask you arrange some blood for him given his falling haemoglobin.’

And so, for the first time ever, I donate blood. One unit. To Father. Take my blood but come back.

By evening, the BP has increased to 110/70. Good… the Norad is working. He lies in bed with his mouth open with a tube inside. I caress his hair and face. I don’t know if he liked it. I chant my selfish prayers. I see them setting up the haemodialysis before they ask me to leave.

*****************

As Maa and I enter the room this morning, I see the BP monitor. 80/66. Back to where we began. Six days of internet research and superficial consultations have informed me that the reading should not be this after dialysis. Creatinine is 2.15. Urine is zero.  My blood did not work like the magic potion that I thought it would.

We see Dr B, Dr M and others murmur within themselves looking at Father. I can’t hear them but I can read their incompetence for the situation.

‘Situation is critical. Will be so for a while. But we are monitoring closely.’ Dr B tells us. His performance had no conviction. I know what he meant and I told Maa of my fears.

*****************

4.40 PM. I am near the door, leaving for the evening visit. The phone rings.

‘Please come. Dr is calling you.’

‘Yes, I am on my way.’  

4.50 PM. On the way in the car. Another call.

‘Please come. Dr is calling you.’ He passes the call to someone. Dr M. ‘His rhythm is getting very irregular. Going very up and down since afternoon. I don’t think there is much time. Please come soon.’

I feel the tears dripping down my face. There is a red light at 100 metres before the hospital. It is too crowded. There is little time. I get out and tell our driver to go back and bring Maa.

I run. Walk as fast as my trembling legs could take me. Through the traffic. Through the hospital corridors. I reach the door of the CCU. The guard asks me to wait. A few moments later, Dr M comes out, carrying a face of grave concern.   

‘Baba aar nei’

He pauses for my reaction. Maybe he expects me to breakdown holding him.

‘I am really sorry. Time of death, 4.57 PM.’ I had reached at exactly 5 PM. I could not see him leaving.

I go inside. Father is lying on the bed. Collapsed. The BP monitor reads 0. But his chest is heaving. I show Dr M that he is breathing. He shakes his head and then disconnects the ventilator pipe. The heaving goes down.

So this is what Death looks like.

I caress Father’s face, head and arms. I rub his bare belly vigorously. I always liked slapping his pot belly.

‘Tch.’ Dr M walks away expressing immense sadness.

I maintain a dignified calm as I am aware of others watching my performance. My tears are silent as I continue rubbing his body. I ask them to remove the tube from his mouth so I can rub his full face and lips and eyes. Maa arrives. She caresses his face once. Tries to close his open mouth but it doesn’t close. She too remains calm.

I overhear her talking to Dr M. ‘We are really very sorry that we could not save him.’ ‘Why did the VT happen?’ ‘Please help my son with the formalities.’ ‘Absolutely, I will just get the paperwork done.’

I keep rubbing his body. I don’t break apart the equipment around me as I used to imagine I will do when the time comes. I don’t grab the nurse or Dr M and beat them. Maybe because I am aware of the 6.5 feet bouncer at the door. I meet the situation without any hyper activity.

5.45 PM. Wednesday. Six days and twelve hours since he lay on the floor of our living room, unable to breath, unable to stand. Never before had I touched death before. But I manage my first time well.

He is very sick.

His heart is functioning at around 25%.

You must have heard diabetes is a silent killer.

We call that artery as the widow maker.

Baba aar nei.

I want to leave by day after tomorrow.  

And so he left. Day after tomorrow.