Life lessons from my dying professor
“What kind of a doctor will you be?”
“An able one, I hope.”
“I hope that you become a doctor who will engage with the problems of the world.”
For an 18-year-old medical student, this aspiration was as professorial as it was intangible. Why worry about global health when the muscles of the back and leg needed memorising? And how did reproductive rights matter when the exam involved peering down a microscope to identify bacteria?
He taught a course called Health, Illness, and Human Behaviour, broad in its reach but not broader than his intellect. A vet by training, this was a professor who challenged his students to think beyond the books. He demanded that we contemplate our privileged position as future doctors and tether it to a moral compass that understood its profound obligation to society. In his view, it wasn’t good enough to be a doctor; you had to be a doctor who cared thoroughly and deeply.
I once wrote a report on the inequities I had witnessed on an elective rotation in my Indian home town. He spent hours refining it and encouraged me to aim high. Months later, I excitedly told him that my essay had been accepted for publication in the Lancet.
“But wait, they want to remove the best bits,” he frowned.
A mention in the world’s most prestigious journal was enough for me but this prolific author had other ideas.
“Tell the editor why your whole essay deserves to be published.”
I gasped at the prospect of committing premature career suicide, but he encouraged me to avoid the easy way out.
“When you own your work, you signal your integrity.”
He was right. The Lancet eventually printed my essay in full and his pride outshone my relief. His lesson would accompany me throughout life, and we stayed in touch beyond medical school.
While absorbing his impressive achievements, I’d relate my hospital experiences, in turn interesting and bruising. He exulted and sympathised, but his greatest ability was his generosity with connections. Through him, I met some wonderful people who eased some of my early career turbulence.
He graced my wedding and hurried to neonatal intensive care to check on my newborn. In the ensuing years, I discovered my rhythm as an oncologist and mother, but we communicated by way of books and writings. I loved his assumption that I should be interested in cancer discoveries but also global poverty, the Silk Road, and the lives of elephants.
After age 80, his memory began to fade. But whenever I visited, he showed the same delight and asked the unmissable question: “So, what are you writing now?”
A milestone came when I dug out a yellowing copy of that essay in the Lancetand slid it before him.
“This is simply wonderful,” he enthused.
“Do you remember it?” I asked, thinking of the countless times he had avowed it to be his favourite piece of my writing.
“No”, he said apologetically. “Should I?”
Ignoring the lump in my throat, I shook my head.
At age 90, he was content. Being around him was a masterclass in remaining curious and optimistic rather than being defined by the inevitable constraints of ageing. In the last few months, our 40-year age difference grew more apparent.
“How do I know you?” he would wonder.
“You taught me in medical school.” “Wow, isn’t that something?”
One day I receive a call from his distressed family. He has just been discharged from hospital with scant information, no supports, and zero pain relief. He is agitated and uncomfortable. I rush to find him asleep in a recliner, his eyes sunken and his skin sallow. As I hover over him, his eyes register just a flicker of recognition, and he sighs deeply. For some tense seconds, I lose his pulse.
The only opinion left to give is one I had never pictured myself doing: “I am afraid he is dying.”
The truth sinks in amid stunned silence.
“I am sorry.”
I sit at the kitchen table where we have shared happy times and call the community palliative care service to refer my favourite professor for endof-life care. The kind secretary asks if a doctor has attended the patient; I reply that his usual practice won’t accommodate a home visit.
Suddenly she exclaims: “You’re the doctor who writes!”
I have never been so grateful for the name recognition if it hastens the formalities, although I know help would have arrived in any case. A nurse calls within the hour and arrives the next morning. As for so many dying patients, palliative care comes to the rescue, again.
On the day he turns 91, he wakes briefly to hear his grandson sing Happy Birthday, express relief at being home, and tell his family how much he loves them. Then, it is as if he determines his work is done.
Quiet, competent palliative care bridges the gap between grief and acceptance. Pain relief and sedation bring an atmosphere of calm to a situation that could easily have spiralled out of control.
Even the dog senses that his death is imminent as she quietly licks his passive hand. I track his thready pulse and trace his infrequent breaths, the finality both real and jolting that a man so accomplished and admired has finally grown silent. We remind ourselves that to be at home, surrounded by loved ones, free of pain and agitation, is how most people would define a good death.
The next morning, I help his daughter and a nurse dress him for the last time. We remove his wedding band as his hand in mine grows stiffer by the minute. His daughter lays a fragrant flower from the garden on his pillow.
He looks serene. And then, it really is time for the very last goodbye.
I whisper a silent thank-you for a sustained and sustaining relationship forged over 30 years. I add a special thank-you for making me a stronger writer and tell him I will miss him.
I imagine his voice urging me to be not just any doctor but one who engages with the problems of the world. I will keep trying, I promise, before walking away and willing myself to contemplate not the loss but the legacy.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar
I imagine his voice urging me to be not just any doctor but one who engages with the problems of the world