June 27, 2017

Suicide by Santhara? I saw it in India.

By John Guy LaPlante

You’re wondering, what is Santhara? Simple. Pulling the plug by refusing all food.

It’s unknown in the United States, but it has taken place in India among Jains for centuries. It’s big news there right now and that’s how I thought of writing this. Big news because it is said that Santhara is unconstitutional. It is heading to their Supreme Court.

How come I know about it? I went to India in 1997 with two Indian friends—Sulekh Jain, who was a PhD mechanical engineer, and his wife Ravi. They had moved to the United States by way of England as part of the great brain drain from India then– doctors and engineers and other professionals bailing out for better opportunities in a better country. They made it to the U.S.—under great odds– and proudly became voting Americans.

Sulekh and Ravi are Jains. They practice Jainism, which is a very ancient religion – far older than Christianity. The Jains are a small minority in India – only 3 or 4% – but they are influential – tremendously influential. They have a far bigger role in India’s culture and government and economy than their numbers would suggest.

Sulekh and I had been friends for 15 years or so—more than 30 years now! Too complicated to go into details, interesting though they are. Sulekh kept telling me, ” Brother John, someday you will come to India with me for a visit!” I thought it was just talk. Who wouldn’t? Well, it happened. He calls me “Brother” a lot. It’s a Jain thing. Very nice.

Sulekh was going for a special reason. At that time there were about 40,000 Jains here. All high-achievers. And he had been elected their national American president and was going to India on a goodwill visit.

He planned to crisscross India and visit major Jain centers all over the country. And I was going to tag along. Can you imagine that? I’d be dunked into that fascinating Jain culture and enjoy incredible sight-seeing along the way!

I was the director of marketing at AdCare Hospital in Worcester in that then. The only way I managed to get the time off was by promising my boss, the hospital president, I’d call back to discuss hospital business if he felt that necessary. Turned out he was easy on me.

Sulekh wanted to tell fellow Jains what living in the United States is really like. Wanted to raise money for a chair in Jain philosophy and religion at a major American university.

Wanted to set up a bureau to make it easier for parents to meet and make arrangements for their children. Jains believe in arranged marriages; young men and women are driven by passion and superficial factors, such as looks.

A crazy concept to us. We believe in falling in love. Romance! But as Sulekh reminded me more than once, consider our huge divorce rate. He and Ravi had met on the day before their wedding. All arranged by their dads.  “Brother John, we believe that love will come,” he would say. And to my eye love did come to them.

I had never been to that part of the world so imagine my excitement, my curiosity, and my apprehension. Yes, apprehension. How would I do there under all that culture shock!

And it was a shock. I hardly got to see another American or another Caucasian in all those weeks. And the different customs I would bump into. Too many to get into here.

To repeat, we toured much of India. It’s a big country and it’s surprising how many cities we traveled to. Mostly over the road, although a bit by train and one plane flight.   We had a chauffeur driving us; unthinkable for us to do the driving–too dangerous. Time and again we went by wrecked cars and huge trucks, left by the road after a bad accident.

We saw amazing things of course. Fantastic, wonderful things of all kinds such as the great Taj Mahal and Gandhi’s home and amazingly ornate temples built long ago and sights we get to see only in National Geographic or TV. And of course the poverty and affliction—make that afflictions–that affect many Indians.

But what I want to get to right now is how I got to witnesss Santhara in the very act of it.

Well, we visited an ashram and met Jain monks and nuns. Were told of an old nun who was in mid Santhara. Were led to her room. She was in bed. In her 80’s, I guessed. Conscious but very weak.

A nun was sitting at her side helping her sip water. The poor old lady acknowledged us but could not speak. Sulekh and Ravi were greatly touched. They chatted in low tones with her nurse. It was all very solemn. Their language is Hindi. I understood nothing. Finally we tip-toed out.

Then Sulekh explained to me that the old nun after due reflection had decided her time had come to leave our world. Her time to die. So she was taking the next step. Santhara. To Jains it’s a concept completely moral, long accepted, in fact applauded…she wasn’t the first by far and wouldn’t be the last. Not many choose that way. Just a small number.

Later, back in the U.S., Sulekh told me that the old nun had gotten her way.

I was shocked, of course. I always thought that we live on and on until we die. If we got old and very, very sick and went through great pain, that was our lot. Our lot until we died. That was the nature of things.

Bottom line, suicide was unthinkable. A sin. Illegal. Shameful. You had to be crazy to do that. What I saw the old nun doing—so pre-meditated, so public, so calm–was a totally new and troubling concept to me. But it did give me a lot to think about.

Some time later, back home, I had another experience quite similar. I was a great admirer of Scott Nearing. Economist, political scientist, writer of dozens of books, public speaker for decades, farmer, social activist, world traveler, father of the back-to-the-land movement, morally driven vegetarian, champion of self-reliance.

A remarkable man, so impressive and admirable, with fans around the world. Walking to a different drummer in so many ways. Look him up on Google or Bing or check his many books at Amazon. You will be fascinated.

I was profoundly affected by several of his books, “Living the Good Life” especially. Here’s just one of many ideas I picked up from him in that  book: he divided each day into three parts … physical work, intellectual work, and cultural enrichment. Lived that way day in and day out for decades.

Also by his remarkable wife Helen and some of her books. Look her up, too.

Well, just short of his 100th birthday, after remaining working and vigorous till near the end, he decided it was time to go. Made that decision calmly, in full possession of his faculties.

I’m guessing he had heard of Santhara because he was grounded in many cultures and philosophies and had visited that part of the world.Anyway, at 99 he acted. What did he do? Simple. Took to his bed. Stopped eating.Just like the Jain nun. And died in 18 days. Helen was at his bedside.

And that gave much to think about.

Now, about a traumatic experience I had when I was 20 years old. My college roommate Gil and I got summer jobs as orderlies at Long Island Hospital. Not Long Island, New York. Long Island in Boston Hospital. I was a pre-medical student at Assumption College, largely because my mother wanted me to be a doctor. Gil was pre-dental. We got the jobs because Gil’s aunt was a head nurse at the hospital.

Long Island Hospital was an affiliate of the great Boston City Hospital. It was a huge complex of buildings. They were linked by tunnels because of the harsh winter winds. The only other thing on the island was a long-deserted fort. You could see the high buildings of downtown Boston, a 45-minute ride away on the hospital’s ferry.

The hospital had some 3,000 patients ( !!! ), half substance abuse and half medical, nearly all indigents. The sick ones were there because of long-term illnesses terminating with death. At the end, most– those whose bodies were unclaimed–were buried right there in the potter’s field. They could see it plainly out their ward windows.

Gil and I were replacements for the professional orderlies on vacation. Bed-pan orderlies we were. We worked in separate wards on eight-hour shifts. Sometimes days, sometimes evenings. Men’s wards. Each with 16 patients.

I covered two wards and so did Gil. A nurse covered half a dozen wards, maybe more, and oversaw us. But we were mostly on our own. The care was good but basic. No dramatics.

All of us staffers lived there on the island. As in college, Gil and I shared a room. Once or twice a week we’d ride our tiny ferry into Boston for an evening out. You know, for an essential change of ideas. By the way, that’s how I got to see my first burlesque show! Lots of fun. On the island, for recreation on a soft summer night, we’d walk down to the pier and watch the harbor traffic.

Long Island Hospital has been closed for many years now. It’s just a specter of starkly empty buildings.

Our jobs were to do whatever we could to help our patients. We served them their meals at their bed. They were lined up in two long rows. We had curtains we could draw between them for that requited privacy.

We’d change them into fresh johnnies, or get them on and off a bedpan. We had to spoon-feed some. Cut their hair, shave them, cut their finger nails and toe nails. Bathe them in the tub or help them shower if they were not up to all that themselves.

Some could make it to the toilet. Others could not but didn’t need a bedpan. So we’d wheel them to the bathroom, get them onto the toilet, then lift them and wipe them, then get them back to bed.

Very demeaning and humbling for patients, no doubt, though they got use to it.

Or so it seemed. Very sobering for me.

A man died one evening. My third day on the job. I was alone. Had never seen someone die. What, what to do? I called a professional orderly on duty in another ward. He came with a gurney, closed the curtains around our patient—though all the other patients were aware of what was going on. They had seen this before. One day it would be their turn.

The pro went to the head of the bed. He told me to take the man by the feet. Which I did. I expected my partner to lift the man by grasping him below the armpits. No. He grabbed him by the head! By the head! I was shocked. I was only 20, just a college kid.

We carted him to the morgue. I had never been in a morgue, of course. We left him on the gurney for the morning shift. There were other bodies. They would all be buried in the potter’s field right next door, in plain view. I didn’t sleep well when my shift ended that night.

I got to see the RNs. All those I saw were dedicated, conscientious, sweet ladies. They did their best.

There were only four doctors in the whole hospital—all immigrants breaking into American medicine. I never saw one come into my ward. It seemed that they pronounced a diagnosis after examining a new patient and prescribed the appropriate care and medicine and that was that. Well, that was the way I saw it.

I remember one patient. Ernie. A little Jewish fellow. About 45 years old. I’m not sure what his disease was. We were given little info. It was plain he was in agony. He was bedridden. And he moaned and groaned. He had developed a huge bedsore at the base of his spine. The size of a grapefruit. It was raw. I had never, never seen anything like that.

He would holler. Yell. Plead. “Help me! Help me! Ple-a-s-e!” The whole ward would hear. All I could do was put an inflated “doughnut” under his monstrous bedsore. Every half hour I’d roll him over a bit. This side. That side. Poor guy.

That went on and on. No let-up. Despite the nurses’ best efforts it was only getting worse. One thing was obvious to me. I’m not sure his basic illness was life-threatening. Perhaps not. But he was in such unrelenting and uncontrollable pain, and his future in the ward must have appeared so long and so grim, that I believe that he would have pulled the plug that very day if he had had a way to do it. Enough is enough!

I knew that’s what he would have done. The nurses knew it. There was little more that could be done. Nature had to take its course. That was the thinking.

But must we wait for nature to take its course? Is that true? Of course, I thought about it. And thought about it. Suppose that I had been Ernie? Would I have wanted to soldier on through that horrible and never-ending pain? Hell, no!

September was approaching and Gil and I left the hospital to go back to our classes. I never found out what happened to poor Ernie.

I dropped out of pre-med. I had gotten an absolutely skewed view of medicine. Yes, badly skewed. So did Gil, of course. Maybe I should have persisted. But I’ve never regretted my decision. It saddened my mother for sure. But she bounced back. Gil became a dentist. He was an usher at my wedding.

(That September back at Assumption, I got elected editor of our small college newspaper…and I found that exciting. So that’s what got me into doing what I’m still doing.)

I’m tempted here to go into the story of Dr. Jack Kivorkian. He made huge news for months and years by helping people who wanted to die by helping them to do that. But only after he had determined it was a reasonable request for them. TIME Magazine called him Dr. Death in one cover article.

But many people thought of him as Dr. Mercy. What he was doing became known as physician-assisted dying. He finally was convicted on criminal charges and served prison time. You probably remember all that.

I believe that he was driven by his conscience to do all that. He wanted to help people. That was it. He never asked for a penny for his services. Never accepted one.

He changed the thinking of many. And had a huge impact in bringing about legislation in a few states to legalize that. His is a complicated story. I could write another long article to cover it even summarily. And the very tiny role that I had in it. He certainly had an impact on my thinking.

And now, Santhara! An ancient Jain practice for centuries. If it makes sense for them, why would it not make sense for others? Maybe you and me some day.

Well, it does. And the proof of it is what is happening in the United States right now. That, plus Dr. Kivorkian’s huge influence.

Five states have now authorized physician-assisted death. The first, of course, was Oregon. That happened several years ago now. And it seems to be working appropriately and effectively. Nobody is rushing to go through that. Surprisingly few.

And now the latest is California. That’s extra-significant because its population is so huge and it has so much influence nationally. There had been grave doubts that Gov. Edmund (Jerry) Brown—a Catholic and Jesuit-educated–would sign the momentous bill. But he did, saying he might appreciate this new right to die himself some day.

More states will okay it. Increasingly Americans–like the Jains with their centuries-old Santhara–are becoming convinced that for some people approaching a dire and terrible end, it’s fine to spare themselves by bowing out and saying goodbye.

It’s so comforting to have that “out” if someday we realize we’ll have the bad luck to suffer an awfuland drawn-out death. Don’t you think so?

But now, thank God, there’s also the possibility of Hospice. A brand-new idea, and what a good one.

I know this has been a long and rambling piece. I could easily have gone on longer. After all, most of us—if we don’t get killed by a quick heart attack or something like that—will live to face this someday.

Anyway, thank you if you’ve gotten all the way to the bottom here. If you think I’m wacky, let me know. But please tell me why.

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