By Ravi Shankar
My friend, Dr Ramesh Kumaran first shared the shocking news with me on WhatsApp. Along with a recent photo, the caption mentioned ‘Mourning the sudden and untimely of our dear Joseph Francis (6th batch). May his soul rest in peace. 6th October 2022.’ I felt sick in the pit of my stomach. This was the first mortality among our MBBS batch mates. One of our friends died when he was studying for MBBS, but he had left the course and was suffering from a prolonged illness. Some of our batch mates had close encounters with death during the ongoing COVID-19 pandemic.
I was reminded of my own mortality and the fact that we often forget that our time on earth is limited. None of us know when exactly or how we will die. This I believe is a good thing. Movies have explored the sad state of people who knew or supposed they knew when and how they would die. Humans stride through life assuming their immortality. We kill fellow humans indiscriminately. We learn to hate each other. We pursue wealth and power. When we leave our material existence on Earth, we can take none of the accumulated wealth and power with us. The ancient Egyptians believed otherwise and buried their Pharaohs with all they would need in the afterlife. Ordinary people had no such privileges. We do not know much about the afterlife. Here science ends and we enter the realm of religion.
I facilitated a module on Death and Dying for medical and other students and our ignorance about death is profound. Modern medicine has the motto of preserving life regardless of its quality. We have not been trained to let go and make a person’s remaining time on Earth worthwhile. This is slowly changing but change is slow. We do not live life assuming that any moment can be our last on Earth. The Tibetan Book of the Dead (Bardo Thodol) tells us to live each moment in a spiritually fulfilling manner and mentions that we all have the potential to break free from the cycle of reincarnation and become spiritually enlightened beings.
I first met Joseph when I joined the Men’s hostel and the undergraduate medical (MBBS) course at Thrissur, Kerala, India. Our seniors were prowling around our floor abusing us and one of my friends was crying as he had just been forced to take off his moustache. Ragging still exists in India and students who were abused by their seniors wait for the new intake to take revenge. You are not able to take revenge on the powerful, so you take out your anger on the powerless. We see this all around in the modern world.
Joseph stayed in a room near mine, and we became friends though not extremely close. One of the things I still remember about him is that he used to write with a fountain pen and used black ink. Even in those days when writing was still common most of us used ballpoint pens. He had impeccable handwriting. Joseph was always a perfect gentleman and willing to help others. I believe we did a few of our internship postings together. We collaborated on skits and other presentations during the college day celebrations. I still remember our college trip to Trivandrum Medical College for the Intermedicos festival and we stayed and slept in the badminton court inside the Men’s hostel. Life was simpler in those days. We were beginning to see the end of the MBBS doctor and specialisation, and super specialisation was becoming common. I feel this is a sad development and an MBBS doctor is competent to treat most illnesses. In fact, evidence shows that most illnesses can be handled by a trained paramedic. In most European countries, care is mostly delivered by general physicians while in the United States care is mostly provided by specialists. The amount spent and the health status of these countries/regions tell their own story.
During those days, failure in MBBS examinations was common. Anatomy at the end of the first MBBS and Medicine at the end of the Final MBBS had the maximum casualties. Grading was arbitrary and there were no clear rubrics to guide the scoring. I was lucky to have squeaked through the anatomy dissection and the medicine courses. Joseph was unlucky and mentioned this often as due to his failures, he could not appear for the entrance exam of PGIMER, Chandigarh, one of the top postgraduate institutes in the country. One could not appear for the entrance exams failing the MBBS. A lot of effort has gone globally into changing the assessment system in MBBS and making it fairer and more objective.
Joseph used to join us for an occasional game of basketball. I next met him at Ollur, near Thrissur, when I was doing my post-graduation. St Vincent de Paul hospital was a multi-specialty hospital. I had come down to Kerala for a few days and stayed with Job and Joseph, both medical officers with who I shared a large apartment.
Over the years I lost touch with Joseph, and I next interacted with him in 2018 when I joined a WhatsApp group of my classmates. Joseph was very active in the group and was working as an anaesthesiologist in the United Kingdom. Many of my batchmates were working in National Health Service (NHS) and they often would mention how the NHS is being steadily starved of funds. The COVID pandemic hit the medical community hard. Doctors in practice seem to be especially vulnerable. We discussed this and postulated that it could be because they are exposed to repeated doses of the virus in high concentrations from multiple patients. Many doctors had lost their lives; many others I know were in the Intensive Care Unit for prolonged periods of time. Two of my classmates in the UK had serious illnesses requiring hospitalisation and prolonged intensive care.
I next interacted with Joseph when I was unable to make a bank transfer to the UK to pay for membership fees of a professional organisation. The transfer was not going through and eventually, I asked Joseph if he could do the transfer from his account in the UK, and I would deposit the money in his account in India. He readily agreed. Joseph was always very helpful. During the last two years, I have lost several friends. Two academic collaborators, one in Malaysia and the other in Yemen passed away. Colleagues I knew in Nepal died due to COVID complications.
Death can be a celebration of a person’s life. An Irish wake is one last party to honour the deceased. Unknown diseases plagued the Irish countryside causing a person to appear dead. Hence a person would be waked in the deceased’s home for at least one night. I had the exact fear while certifying death. What if the person then woke up and disputed my certification? I was very careful and meticulous while writing out a death certificate.
These deaths have underscored my own mortality. As someone once said, death and taxes are inevitable. Accepting one’s own mortality and coming to terms with our eventual demise makes you aware of the folly of chasing power and glory and can contribute toward a gentler, more decent world. Climate change is a testament to human greed and folly. We are still uncertain how liveable Earth will be during the next hundred years. As Mahatma Gandhi said, we can satisfy human needs, but we cannot satisfy human greed!
 Postgraduate Institute of Medical Education and Research
Dr. P Ravi Shankar is a faculty member at the IMU Centre for Education (ICE), International Medical University, Kuala Lumpur, Malaysia. He enjoys traveling and is a creative writer and photographer.
PLEASE NOTE: ARTICLES CAN ONLY BE REPRODUCED IN OTHER SITES WITH DUE ACKNOWLEDGEMENT TO BORDERLESS JOURNAL