The Atlantic

India's Movement to Help People Die Better

Volunteers are taking the care of their terminally ill neighbors into their own hands.

Source: Camilla Perkins / Mosaic

Thirty years ago a young anesthetist, newly appointed as head of department at Calicut Medical College Hospital in the Indian state of Kerala, encountered a case that would change his life.

A college professor aged 42 with cancer of the tongue had been referred to him by an oncologist. The man was in severe pain, and the anesthetist, M.R. Rajagopal, asked if he could help. He injected the mandibular nerve in the jaw in a procedure known as a nerve block, and told the patient to return in 24 hours. Next day, the pain had almost completely gone and Dr. Raj, as he is known, was pleased with his work.

“He asked me when he should come back. I told him there was no need to come back, unless the pain returned. I thought he would be happy I had cured the pain. Instead, he went home and killed himself that night.”

It turned out that the oncologist had avoided explaining to the college professor that his cancer was terminal. Instead he had said he was referring him for further treatment.

“It was only when I told him there was no need to come back that he realized his cancer was incurable. He went home and told his family it was all over.”

Dr. Raj reaches for a glass of water. We are sitting in his simple home in Trivandrum, the leafy state capital, where he now lives with his wife, Chandrika, a pathologist. In front of us, a plate of yellow jackfruit gleams in the low afternoon light. A fan whirrs above.

That experience caused Dr. Raj to examine his own practice. In addition to putting people to sleep for surgery, an anesthetist’s job is to tackle pain. So what was he missing, he wondered.

“In those days pain was all over the hospital. It was everywhere. We pretended not to see it, but it was there. Injections of morphine were used sparingly, after surgery and for patients injured in accidents. It was never used in cancer pain.”

Medical staff coped with the suffering the same way they cope everywhere. “No one teaches you, but you learn to see only the disease, not the human being who has it. Maybe if there is nothing you can do it is easier to turn your back.”

Dr. Raj had had two earlier traumatic experiences involving the dying. Aged 18, in his

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