Thursday, January 20, 2011

Life is transient.. live each moment

''Krupa, Emma is asking for you.''

That was the first sentence I heard on Monday morning as soon as I stepped into the facility. I hadn't even entered the rehab room and put my stuff away, when the charge nurse caught hold of me. ''She has been shifted to room 14 A,'' she informed me, and continued with her daily routine of passing around the medicines to the residents. I stored my bag away, quickly downed the remainder of my hot chocolate, and donning some gloves, I knocked on the door of room 14 A. I entered it quietly, careful not to disturb the other patients. All I could hear was the dull hum of the ventilator another patient was put on.
''Emma?'' I edged towards the side of her bed and put my hand on her frail one. It seemed thinner than I remembered it to be. ''Emma?'' I called out again, and placed a hand on her shoulder. She could barely open her eyes, sedated by heavy doses she received daily for her medical instability. ''Who are you?'' she managed to say in a weak voice. ''It's me, Krupa.,'' I tried to sound more cheerful than I actually felt at that moment. ''Don't lie to me, you are not Krupa. She has gone. They sent her away.'' My heart sank. This was one of the worst feelings in the world. When a person you love so dearly does not even recognize you, it feels like a stab. If I, being her therapist since only 10 months felt that way, I could not even begin to imagine how her own family felt.

At the age of 93, Emma was one of the most energetic patients I knew, always talking, always asking questions, curious to know and learn more. Seldom do you come across a four foot tall 93 year old with such a zest for life and love for family. Emma was one of those rare ones. She was one of my favorite patients, and I will admit, I did spend a lot of time with her outside the set therapy time provided to me. She was first put on my schedule in April 2010, and since then, I used to see Emma everyday for Occupational Therapy. My interaction with her consisted of getting her dressed and out of bed, wheeling her into the rehab gym (sometimes happily and sometimes against her will), exercising her upper extremities to maintain and increase whatever strength she possessed, and for general overall conditioning. She was suffering from poor vision, but even that was not a barrier for her when it came to exercising. She loved it. She would ask me for new things to do everyday, she would want to know who all are present at that time in the gym besides her (yes, she was pretty nosey that way), and she would love it if she could memorize everyone's names. I was her favorite person in the whole facility. She would randomly call out for me at odd times in the day, and if I was around and available to see what she wanted, she would just ask me ''how are you?'' and leave it at that. I would hold her hand and assure her that I would see her everyday, whether she would be a candidate for therapy or not. Her highlight of the day would be when any member of her family would visit her. She would make it a point to ask about everybody at home and how they are doing. ''Wow, you have a good memory for names don't you,'' I marvelled once, as I heard her conversing with her nephew. ''She does!'' he proudly beamed, and kissed her on the forehead before he head out back home. ''Family is everything, it is very important to have family around you,'' Emma stated as she teared up, watching her nephew leave. I nodded in agreement, then wheeled her into the dining room for lunch.

It had been the August of 2010 when Emma started hallucinating. I noticed this happened during lunch times, when she was often kept around other patient's who had similar problems. One afternoon, she was mumbling something under her breath. ''Emma, is everything okay?'' I asked, obviously concerned. ''Sshhh, I am talking to my nephew in Israel. Be quiet.'' At first I thought she was joking. She had a sharp mind, so I expected a reasonable explanation for that. I inquired again and she replied in the same harsh tone, as if very irked at being disturbed mid conversation. I kept quiet and just observed her. She seemed to be having a very intense conversation I sensed from the furrowed brow and intense lines on her forehead. She talked then waited, as if for some reply, and then spoke again. Auditory hallucinations, I thought to myself. A classic sign of schizophrenia. I was a little disturbed. I guess in those few months that I had been treating her, I had conveniently overlooked the fact that she was definitely prone to various illnesses, just like any other patient. I guess I was still in denial that something so profound would affect that razor sharp mind. Pathological, yes. But mental, no. My mind refused to believe it. Unfortunately, it was true. This was just the beginning of a major illness, still to manifest in its worst form.

Since that fateful day, her condition progressively worsened. She had multiple trips to the hospital, and when she was back at the facility, she would be heavily sedated just to keep her from screaming and getting violent. On one occasion, she had even attempted to hit a nurse by waving her arms at her violently. Then onwards, she used to be heavily medicated almost all day.

The brightest part of my day at work was when I would sit with Emma and have conversations with her. Funny, insightful, and extremely engrossing, she would talk non stop. At the age of 16, she and her family had lived in India for a few years. I was surprised she actually remembered the name of a couple of areas, and a famous bakery that stands till date. ''Colaba!'' her eyes would light up, ''We lived there for almost 3 years!'' When I asked her if she learnt any Hindi at all from the locals then, she would frown hard trying to recollect something that was almost 77 years old, and then suddenly come up with ''Kya mangta?'' in her cute accent. I would crack up and she would grin her toothless smile listening to my laughter. ''God bless you always,'' she would smile and I would give that tiny thing a big hug. Her bony body felt almost like nothing and I was scared I would break something if I was not careful.

A couple of months prior to now, on another of her recent re-admits from the hospital, I was working at another facility too to help them out due to lack of therapist's and excess patient caseload. So I would just see her in the morning for 2 minutes and then directly the next day. She was fairly stable now (only comparatively), though of course not fully normal, but less violent and she did recognize a few faces amongst us. One afternoon during lunch, she suddenly asked for me, ''Where is Krupa? I want to meet her!'' I had already left for the day to help out at the other facility. A colleague of mine went up to her and said, "Emma, Krupa is not here. She has gone to another facility." "What?? You sent her away? You are all evil people!" My colleague regretted that the moment she said it. She tried re-phrasing her sentence saying ''Oh she's going to be back,'' OR "She is needed there right now'', but all in vain. That one sentence triggered a wave of emotions in Emma, and her mind contorted the plain sentence in several different ways only the way a schizophrenic mind can. She had it set in her head now that Krupa had left her and gone. Krupa did not work there anymore. I heard of the incident the next morning and immediately went up to her room. She was tossing and turning uncomfortably in bed. ''Emma?'' I called out, hoping that she would recognize my voice, and then seeing me would make her feel better. Instead all I got was a cold ''Who are you? Go away!'' ''Emma, I am Krupa!'' I was taken aback at her reaction. She had never done this to me before. ''You are lying! They sent Krupa away! You are not her, go away!'' she was almost trembling with fury now, so the wise thing to do was to keep quiet and move out.

It has been 5 months now since her condition deteriorated. This morning, I walked into her room to an empty bed. The worst thought struck me but I quickly shook it away. "Where is Emma?" I asked the nurse in charge. ''She had to be taken to the hospital, her respiratory rate went down to 40." I said a silent prayer in my mind for her. I walked outside and stood in the sun for sometime. Unexpectedly, this bit of news had given me the chills. It was hard for me to digest. I used to listen to such news everyday, watch patients go in and out of the hospital, listen to them scream in pain, be taken for dialysis 4 times a week for 6 hours/day; it was all a part of my job. But I would have expected Emma to be the last patient to go through this. This incident just hammered the fact deeper into my head that life is transient. Live each moment to the fullest.

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