Highest form of Compassion

I have been reading and meditating on Tamil devotional literature over the past few months. I started reading and interpreting the verses of the great Tamil devotional poetry titled Abhirami Andadi, which sings the praises of the universal Godly principle, that is in the form of Goddess Abhirami in the village of Thirukadaiyur, in the Nagapattinam district of Tamil Nadu. The author, Abhirami Battar, who has penned these 100 verses of poetry in easy-to-understand Tamil, must have been in a state of spiritual enlightenment as he penned these verses and his spiritual journey is captured in the songs. Following this my interest in Tamil devotional literature increased and I followed it up by reading the great Tiruvasagam, literally translated to mean the Divine Verse. This was written by the great Shaivite poet, Manickavasagar, in the 9^thcentury and it comprises of 51 chapters. The poetic, aesthetic and devotional sensibilities of this poem are beyond description and there is a very old saying in Tamil which goes, “Thiruvasagathukku urugaar, oru vaasagathirukum urugaar”, which means the one who does not melt after reading Tiruvasagam, will not melt for any poetry. Manickavasagar must have also been in a heightened spiritual state as he wrote these verses, and these are very clearly perceivable in the poetry. I am currently reading Tiruvasagam and am meditating on its spiritual interpretations. It is in this context that I saw a couple of elderly patients in my routine Sunday clinic. 

 

Two young men came inside the clinic building in an autorickshaw and seated between them was a frail, bent over, old lady with hair as white as soap lather. One of the men got out of the auto and deftly carried the elderly lady inside the clinic. She was so small and bent over that he could carry her easily in his arms like a little child. He laid her on the examination couch. As I walked out of my room to the examination couch, I could hear her soft grunting sounds. The lady was in obvious pain. The nurse ran ahead of me and checked the elderly lady’s pulse rate and blood pressure and wrote a case sheet and handed it over to me. Worry was written all over the face of the two men who were standing beside the bed. I went near the lady and put my hand on her bent weather-beaten back and gently caressed her. I asked her, “what brings you here amma?” The lady continued to groan and did not make eye contact with me. The man who carried her to the bed told me, “Sir, she cannot hear.” I looked up and asked him, “tell me sir, what happened? What is the problem?” The man said, “Paatti has not been eating since 4 days. She is not speaking, she is not saying anything. She is continuously moaning and groaning. It is very difficult to see her like this.” I asked some routine questions regarding fever, breathing problems, past history of diabetes, high blood pressure, got answers and noted them down. One thing that was obvious was that the elderly lady was in distress. Her forehead that was already creased with lines of old age, was further marked with creases of pain and a frown of discomfort. Her eyes were closed, and she was groaning. Her history also revealed that she was a patient of some heart disease, the details of which were not known, and she was taking medications for the heart disease. She had stopped the medications. 

 

I performed a detailed examination of this lady. Usually, patients like it when I examine them. This lady was apathetic to my touches and my examinations with the stethoscope. There was nothing remarkable in the examination. After I finished my examination and got up, the lady opened her eyes for a fleeting moment and our eyes locked. Her dry, densely cataract ridden opaque eyes, seemed to beg me to relieve her of the suffering. Those few seconds when we made eye contact, I could distinctly sense that she was asking for mercy to be relieved from the body inside which she was trapped. I felt uncomfortable to address that idea and I got up and rushed to my room, where I sat and wrote out a prescription for vitamins, pain killers and some balms to apply on various parts of the body to relieve pain. I told the grandson that her suffering is because of pain and ageing and I sent them away. I felt highly incompetent and helpless as I watched the grandson carry the lady back into the auto with her continuously groaning. As he turned out of the clinic carrying the lady, she once again opened her eyes and made eye contact with me. I saw a sense of betrayal and disappointment in her eyes which poked me deeply in my heart. 

 

A few hours later, I saw another elderly man, about 75 years of age. He was having a severe breathing difficulty even as he slowly walked inside my consultation room and sat in front of me. His wife accompanied him and sat by his side. The man was bent over and was panting for breath. In a few seconds his breathing settled, and he looked up. His face was creased up in pain and suffering the same way that the older ladies face had been. He looked straight into my eyes, held my hands and tears started flowing down his cheeks. He begged me, “Doctor, do something and let me die. I cannot deal with this breathing problem anymore. I want to die in your arms. I want you to send me safely to heaven”. This man was suffering from a terminal heart condition called restrictive cardiomyopathy, as his heart muscles had become fibrous and stopped functioning normally. The only option to help him was to give him a heart transplantation, which is not easily available in India, and not an option for the poor, living in remote rural locations. I have been maintaining him on medications to remove fluids from his lungs so that his breathing is smooth and effortless. But sometimes he runs out of tablets, and he goes off medications for a few days as he cannot access a pharmacy or our clinic easily due to the long distance from his home. So periodically his lungs get filled with water and he struggles to breathe. Of late his suffering had increased and this was the reason he was begging me for liberation. This man’s request for liberation was not mixed with a sense of defeat or betrayal. It was a genuine acknowledgment of all our efforts to keep him comfortable and still a request to be relieved permanently. 

 

I am quite certain that all doctors have faced these situations when our patients ask us for a ‘permanent relief’ from their suffering. That day, after I finished clinic and went home, I was troubled for a long time by the thoughts of these two patients. The 95 year old lady who could not even communicate, showed me her sense of betrayal with just her eyes, and the younger 75 year old man with restrictive cardiomyopathy and heart failure begged for death. Then the next morning, I read a new chapter in Tiruvasagam and the chapter is titled “Begging for Compassion” (Kaarunyathirangal). Manickavasagar sings

 

கடவுளே போற்றி என்னைக் கண்டுகொண்டு, அருளு, போற்றி!

விட, உளே உருக்கி என்னை ஆண்டிட வேண்டும் போற்றி!

உடல் இது களைந்திட்டு, ஒல்லை உம்பர் தந்து அருளு, போற்றி!

சடையுளே கங்கை வைத்த சங்கரா! போற்றி! போற்றி! 

Praise God! Bless me and shower your grace on me!

Help me renounce my mind, take over my soul!

Help me shed this body! Quickly liberate me from this suffering!

Oh! Lord who has the Ganga in his hair, Oh! Auspicious Lord! Praises to you!

I realized that begging for death, begging for liberation, begging for relief of bodily pain are all requests for a higher degree of compassion. In a heightened state of spiritual awakening Manickavasagar has asked for a quick death and liberation so that he can be freed from the bodily bonds and just be in eternal bliss. He has titled his chapter, begging for compassion. When I read these verses, I couldn’t control my tears. Just like how Manickavasagar has begged his Lord for compassion, these two patients had begged me to free them. I know I sound very arrogant comparing myself with the Lord. But that is not the intention. The intention is to try and understand that compassion comes in so many forms. Relieving the suffering of people who feel trapped inside their body is one of the highest forms of compassion. I don’t know if I have answers for the two elderly people whom I served that day. I am not someone who is comfortable with the idea of euthanasia. But I am slowly starting to understand that death is not just the end, it is sometimes the beginning of a divine experience of life liberated from the trap of the body! I just pray that I can understand this clearly and if possible, try and practice it some day!