Dr Vidya Viswanath's talk at Palliative Care Congress in Vatican, Feb-Mar 2018

Dr Vidya Viswanath's talk at Palliative Care Congress in Vatican, Feb-Mar 2018



of spring first of March look like this outside so we will continue with our next speaker she comes from India Vidya Vishwanath and she will present us embracing life and facing death the Hindu perspective welcome press the button Namaskar home from my country and I feel incredibly privileged to be here today and I would like to start by thanking pal life for having me here my institution homi Bhabha cancer hospital and Research Center where I work and pallium India where I come from at the moment I'm also grateful that I managed to make it here in my six layers and my six yards of my sari to the podium today I also feel very grateful because I stand here representing one of the oldest known religions to humankind and one of the most humane approaches in medicine which is palliative care I would also like to say that as a palliative care physician I have a long way to go as a Hindu I have a lot to learn all I'm going to do over the next few minutes is talk you through my journey in palliative care as I talk to my patient every day part of this journey is preparing my own self initiating the conversation talking to my patient helping them make decisions working towards bereavement care end-of-life care hospice care and of course self-care what is it that's different in a patient that we see in palliative care these patients are usually at the crossroads they are in severe distress and at any point in time our role is to make them smile through these tears evidence-based medicine great but I really need to lean upon some principles which come from my Hindu values and philosophy and little stories that I have grown up with that is all which will be the content of my talk today in the journey of with a patient facing grief and loss what is our role our role is to ease transitions it is to keep hope alive in the face of despair and it is to maintain the delicate balance between holding on and letting go embracing life facing death is about these transitions and confronting the circle of life from the patient's perspective it means finding some sense of tranquility in the severe Tremmel that they are going through the care giver has their own sense of distress they have to go through a normal life they live with anticipatory grief and even guilt at times and Here I am as a palliative care physician trying to work my way through all of these trajectories so where do I draw my own energy from this is Lord Shiva as we know in Hindu culture and this is a posture which is called which comes from the divine dance or the tandem this dance is demonstrates the cycle of life it transitions between the gentle to the violent and it transitions through birth through death and in all of this in-between the harmony in between everything the Lord maintains pulsating energy with perfect balance and this is the posture which we call as Lord Nataraja in Hinduism and this is the posture from where I like to draw my energy to maintain that balance and find my own equipoise as I initiate the conversation with my patient starting the conversation what is the goal in any palliative care conversation the first goal is what is what can we do for you today how can we improve your life today what is the suffering that I can take away from you today and that is always our goal as palliative care physicians and this is where I can draw from the bhagavad-gita which is the divine song and what does the bhagavad-gita say it says do not weep for the past do not worry about the future think of the present and live in the present and so this is where I start by initiating the conversation with my patient saying this is probably the easiest thing to do but all of us know how difficult it is to practice that and again it is the bhagavad-gita which comes to my rescue because the bhagavad-gita is the epitome of one of the most powerful communications in the world this bhagavad-gita is set in the battlefield it is when the warrior loses courage to raise his arms and go into battle and that is where Lord Krishna who is the prime mover of the bhagavad-gita comes in he is a charioteer to the warrior he does not pick up a weapon all he does is listen to Arjuna and talk him through that entire crisis so this is exactly what the palliative care approach tells us it tells us ask tell and ask in communication it tells us to listen it tells us to empathize and so this is exactly what I try to do with my patient as I am talking through to the patient and helping them make their decisions I cannot make it for them but I need to help them make these decisions having said that decision-making in palliative care itself is difficult it is very difficult for the patient and coming from the Indian scenario we have what we call as collective autonomy so it makes it doubly difficult for the patient but it's also difficult for us as position because every single decision I make what is the question that I asked myself I would like to ask myself am i doing right am I not doing hum that is the first thing I need to ask myself and there are many times when patients tell us they refuse opioids they say we want to bear pain probably it's punishment so let it go away there are patients who say I will believe only in rituals I'm not going to take medications so that is where we need to be both gentle and firm in managing between beneficence and autonomy so these dilemmas are always there with us and again it is the Gita which comes to my rescue what does the Bhagavad Gita tell me it says that it is the intention behind the action which is paramount I am here to do my duty that is what a karma yogi does he does his duty I'm here so as a palliative care physician what am I here for I am here to ease suffering I understand that the outcome could be dead I understand that there is no cure but my duty is to relieve you of the suffering and that's exactly what the Gita says that it is the intention behind the action which is paramount at the same time inaction is not an option like we heard yesterday Palli la liya Pali phobia all these things could be like in action this is not an option because the true karma yogi if he feels compassionately towards those who are dying we have to find a way through this like one of our teacher says she says create the world you want to die in so feeling compassionate is good but we have to translate that thought into action and just like what dr. dorba tri Cross says it is the anger in compassion which is the catalyst for change and that is what is going to spread palliative around so yes we have to be compassionate but we also have to be angry we have to work towards creating the change that we wish to see it is nice to be angry angry anger can be a catalyst but when we talk about integration when we talk about integrating with various other multidisciplinary teams the way to move forward is to build bridges and for this we need the wisdom to discern we need a keen sense of judgment and most importantly we need perseverance and this is where there are plenty of times I get disheartened it's a tough path and that is where I look to my Lord Hanuman who is one of the gods in whose stories we have grown up with since childhood and he is part of the epic which is called the ramen if any of you have heard about it so this is where I look to for my own faith it is often said that rituals are a big part of Hinduism but the way I look at it I feel it inculcate the sense of discipline and it can also bring solace and it can bring comfort for instance the other day we had a patient at the hospice she was a young lady she was really young and she had massive lymphedema because of which she could not get up and she was in the last few days of her life she expressed that there was this puja coming up this auspicious day that we call she would have liked to do this little prayer and this little ritual for her husband which he had never missed over the years but how could she do it she was in the hospice immediately we managed to keep an image of her deity because worshiping through the image of a deity is very powerful in Hinduism it gives you a sense of connect like none other so we got her that little image we got her a little lamp a few flowers and once she did that she died about two days later I hope she died more comfortably and this is exactly what brings us to the concept of what we call hospice care like we have always learned Hospice is not a four wall structure and this is where I draw a very strong parallel with the temple what happens in a temple it is what we feel which is exactly what goes on in a hospice it's a place where I believe that peace and turmoil coexist I have learned life lessons in the hospice witnessing the trauma witnessing the strength inside those four walls I feel really I feel I have no right to complain and when I see someone going through that transitional phase translational phase I always feel it's a huge privilege that we as palliative care physicians have one more thing as palliative care physicians that we always think about is to prioritize unfulfilled desires to fulfill unfinished business we are always charged please do that and there is a very beautiful parallel in Hinduism for that we call it moksha we say don't leave behind anything that you want to do so even as Hindus towards the end many a times family members would like to know what their loved ones want what they want to be fulfilled and what like what we say when life ends and desire remains we call it death but when desire ends and life remains we call it moksha so this is the concept and this is this is what every Hindu would like to achieve to break off from that cycle of life and death there are also some scriptures that we read towards end-of-life in fact one of the oldest treatise that we have towards the end of life it's called srimad-bhagavatam there's a very nice story behind this there was a king who was cursed and he was given seven days to live and in these seven days he did not flee away he did not fear death but he was the scripture was read out to him and that gave him moksha so it strongly believed among Hindus that reading this and being a part of this listening process it's one more way of achieving moksha and as many of you would know going to Banaras being cremated near the Ganga these are all ways that one can achieve liberation from this cycle of life and death many times we meet our patients and caregivers destroy Kali face death they have gone through the grief cycle they have come to this acceptance how do they do it many of them believe that the soul is permanent the body is a gift from God and like we change our clothes the soul has now left this body and has now evolved and this gives them a lot of comfort and this has been coated in the bhagavad-gita – there is another concept which I'm sure many of you hear about is what we talk about karma when we talk about Karma it is not just be determine fate what we believe is that what has happened in the past is a result of what we are today but what is more important is we have it within us to change the future so doing something good now accepting what I have now can give me a better turn for later so it's like what goes around comes around so this concept of karma is something I have kind of just simplified it but this is it's a huge concept in Hinduism and I am no scholar of Hinduism like I told you before but this has given a lot of acceptance to patience to accept what is happening during debt the question that most of us as palliative care physicians fear is why me and many a times we get answers to this question of questions just by conversing with the patients and their caregivers the question remains unsaid but most of the answers are answered so this is this these are some of the experiences that we have had as palliative care physicians bereavement care is again another very important part of palliative care so this is something we are told that we have to meet the family we have to talk to them we have to spend time with them for a long time to rule out complicated grief we have a lot of parallels in Hinduism to even chanting for the dead sitting with them and there are plenty of rituals that go on for almost a year after the patient or after the person dies so what I would like to say here is that our community absorbs a lot of bereavement care so at a personal level and as a palliative care physician most of our work is done by the community because these rituals can go on they start on the next day and they go on till almost a year in all this I would now like to touch upon the fact that Hinduism is also about awakening your own soul because whatever we say and do if we do not have faith in what we are doing everything else does not matter so self-awareness we call it kindling your own Shakti your own spiritual force as we call it it need not be a deity it could be something that you connect very well to so this deity in me or this Shakti in me allows me to multitask but I also understand that I need to introspect I need to reflect and very honestly I have a very long way to go to achieve that sense of equipoise which all of us crave for there is a lot of turbulence but I am very grateful to the practice of palliative medicine because it has taught me to introspect it has taught me to reflect and it has brought me way closer to my own faith as I would conclude I would like to say thank you in true Hindu tradition we say Mata pita guru daivam Marta is my mother she was a teacher for 37 years pita is my father from him I learned to chant mantras without actually learning because I just heard him say it guru is every one of those teachers right from my kindergarten tools to so many even in the audience today whose textbooks and whose articles I have been blessed to read so I've really bow down in respect to every one of you all of you have taught me that I have been encouraged Radha to make my own life choices without fetters and without making it the standard of morality for someone else I have grown with the joy sounds of the temple bells and the quiet silence in my school Chapel and I have cherished both of these I feel truly blessed that I am here today my dear family is my biggest strength and my friends have been the greatest gift in my life every one of those illustrations those pictures in my presentation which we call as Ron goalies which are there on the bars have been made by my friends and some of them are on my own personal pictures so I am grateful to all of them today I'm bringing a part of India right here I bow in respect to every one of them and at the very end I would like to talk thank every one of my patients and caregivers from whom I have received way more than I've given thank you [Applause]

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