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Gran died on her own terms

September 28, 2017

 

Monti Mary Menezes was 97 when she died in her sleep, peacefully, at home.

 

When she slowly slipped into another world, it was an ideal leave taking for Monti Mary, in a way she wanted, on a day she wanted.

 

They fondly called her “Mai” (mother) - her five children, grandchildren and all her near and dear. Mai did not reach a perfect death by chance. She had made her end of life care wishes clear to her family, as with all her other life decisions, big and small. Her idea of dying was pretty clear. She would die at home, in familiar surroundings, among loved ones, in comfort. She was lucky to have a family who respected her wishes till the very end. 

 

Mai was different from the rest of the world. She was the star of all family gatherings. Her five children, grandchildren and great grandchild could not match her burst of energy, enthusiasm. She was an outdoor person. She was very particular about a lot of things - food, prayer meetings, excursions, and health check-ups. She had the last word in anything and everything concerning her life, the ‘my way or the high way’ kind.

 

Though mai never attended school, she lived an independent life as a contractor back home, building houses and digging wells for villagers. She left her village in Mangalore at a young age following a spat with her older brother. Even as her mother stood stunned, knowing well once Monti Mary had made up her mind, it was nobody’s business to change it.

 

“She was a legend,” says Saviana Phulsunghe, her granddaughter. 

 

Once she left her village, mai travelled alone, far and wide, initially within the country, and later beyond. She travelled to Delhi, Chennai (then Madras) and Mumbai. She found help on the way. At times, she had to even spend nights under trucks parked by the roadside. But tough as the journey was, she became tougher.

 

Confident and adventurous, mai found employment easily. She worked in households, mostly as caretaker to wealthy families. In Mumbai, she was employed with Jewish families. Since she was good at her job, getting references and recommendations was easy.

 

While working in Mumbai, at the age of 33, Mai met her life partner, 46-year old Cyril Menezes, through a common friend.   A chef by profession, Mr. Menezes was the perfect match for her. They got married and lived happily. The couple became parents of five children, one boy and four girls.

 

As time passed, they needed more money to take care of the large family. Mr. Menezes decided to work abroad and travelled to Kuwait. He worked as a chef and did well for a few years before suffering a nervous breakdown. He was sent back. This is when mai decided to turn breadwinner, work abroad, while her husband brought up their five children, a task he accomplished with total dedication. Years later, he died at the age of 75, a sudden death following a paralytic attack. Mai worked for many years in the Middle East before returning to Mumbai.

 

Until May 31, 2017, mai was living a normal life. She went for her walks with her caretaker or grandchildren. She lived a peaceful life in her house in Colaba, frequently visited by her loved ones, family and friends . She lived a full life, had a good appetite and slept well.

She was a member of laughter club, had strong views on current affairs. "Are you scared? Don't be,” she would tell her children in challenging times.

 

When mai turned 94, she had a health issue, the first to affect her, persistent, but nothing major. In summer after she turned 97, she found the heat and humidity unbearable and cut down the walk to once a day. She began getting dehydrated and couldn’t handle it.

One day she asked her family to admit her to hospital following severe dehydration. She was planning to be back home two days later.

 

On the second night, mai suffered a massive heart attack. The planned discharge the next morning turned into a stopover at the Intensive care Unit (ICU). She survived the cardiac arrest but was subject to intrusive medical interventions, not something a 97-year old body could endure or a strong willed soul would allow.

 

The episode also changed life for Mai. Her heart had taken a major impact. She had developed new chest issues and an onslaught of cough episodes. Her heartbeat was erratic and she was in terrible discomfort from the breathing equipment and the catheter. Even in the ICU, she insisted she would sit, not lie down, mainly due to her breathlessness. She was labelled a difficult patient. 

 

“Take me home,” she kept telling Saviana, who sat with her in the ICU. She was allowed to sit with Mai since she had refused to lie down, and the hospital did not have enough staff to take care of a sitting patient, more so someone as strong-willed and stubborn as Mai. When they wanted to tie her hands to stop her from pulling off the oxygen mask since the pressure became unbearable, Saviana stopped them.

 

It was during this stage that helpful advice arrived to mai’s rescue. Dr. Sujeeth Rajan, chest physician, who is known to the family heard of her situation and asked Saviana one simple question: “What are you trying to achieve by making your 97-year-old grandmother undergo such aggressive treatment in an ICU in her last days?” It made everything clear. Together with mai’s constant demand to go home, she knew what to do.  

 

Dr. Rajan asked Saviana to contact Dr. Rajam Iyer at Pals Clinic in Bhatia hospital for advice on palliative care. Dr. Iyer, a strong advocate of palliative medicines for patients with life limiting illness. She, supported their decision, but advised them to shift her only if the family was ready to care for her at home until the very end. “Knowing that she is dying, would you still be rushing her back to the ICU if her condition deteriorates further closer to her end?” Dr. Iyer asked the family. If so, she would not recommend a discharge from the hospital and head home. But if the idea was to keep her alive, with a poor quality of life as long as possible, the hospital ICU was the place. The decision, then, was easy. When the family assured they wanted to allow Mai to die a natural and comfortable death as she wished for in her own bed and in her own room, Dr. Iyer agreed to offer end of life care to Mai.

 

The family decided to take care for her at home, as she had wanted them to do. At home, the family followed advice from her consulting doctors as well as from a local physician for emergencies, and odd hours. They hired the necessary machines, from nebulizer to deliver liquid medication, so that her lungs could inhale, to a breathing machine to aid her breathe normally, pushing air into the lungs by keeping the lungs open, allowing more oxygen to enter.

An oxygen concentrator was also used to supply oxygen through a tube placed in her nostrils.

 

On June 16, 2017, mai returned home, as per her wish and to the relief of her family. She had home cooked meals, fed by mouth. She was given symptomatic medication and palliative care. She was taken care well by the family, with additional help from a home nurse and caretaker.

 

As days went by, mai’s situation deteriorated. She became oblivious to the happenings around most of the time. When awake, she used hand gestures to indicate if she wanted water, a change of diaper or when she wanted to be moved to her chair or bed.

 

“Mai never developed any bed sores. In her last days, though she was with us physically, she was also somewhere else, far away, in another world, her own world.

 

On the morning of June 24, her breathing became noisy and laboured. She was not able to swallow food. A constant drooling followed. Her kidneys failed and lungs collapsed. The family called the local doctor, who suggested the usual drill of tube feeding, catheter, insulin etc, and gave 36 hours without those interventions. 

 

The family knew better. They consulted mai’s cardiologist, their palliative doctor and family physician. All three confirmed she was dying, slowly slipping into another, knowing she was much loved and cared for. By afternoon, the breathing became even more laboured and rattled, and she passed away peacefully in the evening. It was Saturday, June 24, the day of Saint John the Baptist, the patron saint of her village in Mangalore.

 

“Mai always wanted to die at home, on a Saturday and buried on a Sunday,” said Saviana.

 

Only in March, the whole family went to Alibaug on a holiday and Mai had the most fun. She sat down comfortably in the water, wanting to go further in when the water receded during the low tide. In April, she wanted to walk home from the church after the Easter Sunday mass and not travel in a cab as usual so she could meet and greet her friends, and look around familiar places.

 

“She was a God fearing person. It probably helped bring all the right doctors in the end to guide us. The only glitch with dying at home, and that too on a Saturday, was to get a doctor to sign the death certificate!”

said Saviana.

 

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