“The earthquake was in Afghanistan,” the old fruit seller said, “but Delhi too was shaken.” He was handing over the second plastic bag my friend had demanded as a backup for the first one bulging with apples and mangoes.

My friend smirked and walked with me to the car.

“What did he mean by that?” I asked.

“Oh, he is nice but a little mad,” my friend replied. “He does not like it when people ask for plastic bags to carry the stuff they buy from him. He used to plead with everyone to get their own cloth bags. He gave up when people stopped buying from him. Crazy guy!”

What does that have got to do with the earthquake?

“He keeps lecturing that we are all one. Earth is gifted to us to by God, it seems. We must all protect it or we will be left with no home. As if, if I stop using a few plastic bags, the planet would be saved. Ha!”

“I doubt if he is even literate,” my friend continued, “but he talks of climate change. Yes, the very words. Climate is changing because God wants to give us a warning, it seems. This earthquake must have been God shaking his fist … ha, ha, ha!”

He was still laughing when I dropped him off before his gate.

I think I will carry a bag or two with me from tomorrow. And I will walk all the way. Why bother with a car when I am supposed to be on my morning walk.

No, I am not thinking of that crazy old man. But why am I thinking of my baby born last month?

You must read if you wish to write. If you are a writer, you must find your reader. You must weigh your words to deliver maximum value. Early lessons.

I started reading early with no ulterior motive. That crept in soon after the professor checked my essay on the college canteen. You are a good writer, she said. Be at it, she advised.

She went to on to make me a part of the editorial team of the junior college magazine. I had arrived, I was sure.

Then I found myself standing at the college gate pleading with all who entered to take a cyclostyled (yes, that used to be a thing) copy of The Junior Rag. The idea is to find your readers, and for that you must go to them, my teacher had said. All I could find was juniors and seniors alike treating the Rag as just that. For the next few days, I stayed clear of the waste bins and random flying bits of paper.

During my year in journalism college, I respectfully approached the instructor. I was carrying a sheaf of painfully typewritten pages. On the pages were words sure to pull readers to the resort I was helping sell. It was my first step into the exotic world of copywriting.

He flipped through the pages as if he were looking at some animation. Then he casually transferred the bunch from one hand to the other as if weighing the pages. “you can expect to get …” he mentioned a price, gave me a patronizing pat, handed the pages back dropping some in the process and moved on.

More recently I cleared out a huge stack of yellowing newspapers from the attic. Each carried a story with what was once rarely obtained, my byline. Explosive exposures, tearful tales, faithful facts. All by a writer who had, as my boss once put it, “strayed” into journalism. The scrap dealer dumped all the bundles on a large weighing scale, checked the weight and counted out the compensation. No, I did not linger for another backward glance.
​
Today, when yet another potential client asks me to quote my price per word, per page or per hour, I revisit my early lessons. Then I weighed every word because I valued the reader. Now the buyer weighs content that must be optimized to be found. 

Procrastination is how you make the most of your time. While you are at it, do thieve some to enjoy yourself. After all, I have just about 800 left and you too have not much left, given that each of us has 4000 weeks, give or take a few.

That’s Oliver Burkeman’s estimate. Just that number immediately tells us what really matters, what is precious. TIME!

So, you have your ways (prescribed and digital) to tame time, you think? “The more you struggle to control it, to make it conform to your agenda, the further it slips from your control,” says Burkeman in his famous book, Four Thousand Weeks.

The problem, he says, is that time management techniques don’t acknowledge that time is limited. When you try to manage it, you no longer enjoy it.

Time was when we worked by the sun. Rise, shine and set, all with the sun. Then came the industrial revolution that made time another asset to divide and exploit.

Are you among those who pine for a bonus 24 to add to your given 24 in a day? It can be liberating if you accept the limit. “The paradoxical reward for accepting reality’s constraints is that they no longer feel so constraining,” says Burkeman.

What if you had all the time in the world to be at your device or at work? After all, there is so much to get done by EOD.

Once you accept time is finite, how do you make the most of it? Burkeman has a few suggestions. Know what must be done now, procrastinate or even neglect the rest. Limit what you take up and know you must choose and settle for some. Most importantly, enjoy what you use your time to do.

As the author puts it, the only way NOT to waste time is to use some of it "wastefully focused solely on the pleasure of the experience.”

Burkeman prescribes giving up some control over time and sharing it with family and friends. You will gain emotional riches when you prioritize the out-of-range, in-person kind human connections over the online.

Want to know how well you gel with time? Burkeman suggests four questions to ask yourself:

• Do you avoid new activities, fearing the outcome may cause discomfort, uncertainty or disappointment?
• Do you hold yourself to impossibly high standards?
• Do you live today as a journey to the person you feel you ought to be?
• Do you hesitate to pursue an activity in which you don’t feel you have the expertise?
• Would you approach something differently if you didn’t need to see its completion?

Accept the answers and get going. Enjoy it while it ticks. 

Dr Christiaan Barnard, the pioneer in human-to-human transplant, had visited India when I was in high school. Not sure if that was the trigger, but around the same time I developed this great interest in medicine, specifically in cardiac medicine.  

Even browsed through all of Gray’s Anatomy when I was supposed to be reading Economics much to the amusement of an indulgent family doctor. As a bonus, I had this fascination for science fiction. So, save little details like studying medicine and learning surgery, my heart was set, well, on heart.

Thank God, that didn't happen! They say heart surgeons are dying out. I thought only writers were at risk. Looks like technology is set to bypass my dream surgeons, too.

According to The Economist, until “the late 19th century, surgeons were convinced that the organ was so delicate that even touching it would cause death.” When cardiac surgery emerged around the 1950s, “it quickly became one of the most prestigious and well-rewarded branches of medicine, dominated by vaunting men who gloried in their power to save those doomed to die.”
​
In 2008-09, heart operations in Britain were at an all-time high of over 41,000 only to fall to 31,000 10 years later. As against this, from 10,000 in 1991, the implantation of stents increased ten times to over 100,000 by 2020. Reportedly, there is ever less work to go around the estimated 250-plus consultant surgeons in Britain, a number that has remained "largely static." 

What is happening? Is a ChatGPT cousin taking over heart surgery? 

When Simon Akam, the writer of the article asked Dr Dincer Aktuerk, a consultant surgeon at St. Bartholomew’s about the future of the profession, the answer was arresting: “I don’t think that the conventional cardiac surgeon, as we know it, will exist in a few years’ time.”

Dr Richard Galloway, a surgical trainee has chosen to focus on orthopaedics. The rationale is more head and less heart. “Everyone’s going to need knee replacements,” Galloway told the writer. “You’re in good business there.”

Back in 1976, while in India, Dr Christiaan Barnard had told a journalist: “You can't be a heart surgeon and be tense.” Tense they are today, going by what Simon Akam has revealed.

I wonder, the next time I meet my writer friends over pints of a morale booster, and we again aver that no technology can ever replace us, will I also run into some cardiac surgeons asserting that no wire can slip through and cut the scalpel out?

Can a disaster that no one wants turn victims into villains?
​An evil scientist has released a dangerous virus inside an aircraft mid-air. All are infected; many die. 
Would you let that aircraft land in your country?
If you are a passenger, would you want to land?
Would you choose to be safe or want to save?
Would you describe those who deployed fighter jets to force the plane out of their country as selfish?
When you force a child to join the section of the aircraft meant for the infected because you have spotted a rash on her hand, whom are you saving?
Why is it that those safe on the ground and those dying in the air have the same question—if the plane lands, can we live?
Can humanity draw hope from the captain’s announcement before he broke all communications?
“All of us aboard this plane have decided not to land. We know what the people on the ground are scared of. We don’t resent them. It’s just that we were caught in a disaster that none of us wanted.
“We are weak and frightened humans. But because we are humans, there are things that only we can do. Now, we intend to make a decision for everyone’s sake. This decision is not to give into this disaster, and to make an honorable choice with our humanity.
“Therefore, we won’t land. For the last time, we send our love to all our families."

These are not meant to be spoilers. These are just some of the questions that came to my mind after watching the Korean movie, Emergency Declaration on Amazon Prime.
I am no expert, but this movie may not be perfect. If you decide to watch it, do not let the telling distract you from the story … and the questions it raises.

The fish swam at ease
Letting the ripples pass
The grass swayed
In pace with the wind
Pebbles and rocks, big and small
Lounged lazily along the shore
The mountains stretched
Unmoving, in green hues
Above all, the clouds
Were pristine white
None knew boundaries
Except man

I saw this image on Sunday Mid-Day, and the connection was instant. Counting on the pen to work its magic. And the family confidently in tow. What follows just wrote itself. 

Hello friend
So happy to see
Another who lives by the pen
 
The same family of three too
Don’t remember the little one
Resting his sleepy head on mine
But can’t forget
Falling on the road
While carrying the older
 
Yes, she too had followed in hope
That the pen would feed us all
 
Look at all those people
They all see
What we have, what we can do
But who cares
Rarely does one stop and buy
What we peddle
 
When we sell one
We are pumped to sell the next
We know
What one pen can do for us
Do they?
 
You will make it one day
It is written in our destiny
The pen shall provide

There is a lizard on the other side of the pale curtain. It seems happy just holding on as the curtain sways.

The old clock ticks on, loud and relentless. The sound fills every gap in the banter and laughter.

He is at the head of the dining table, most convenient to reach on his wheelchair.
“Why don’t you make some tea?” he tells the maid. She is more than a maid. She was the chief help even when his wife was around. She took over as his prime caregiver after the wife’s death and an accident confined him to the wheelchair.

A doctor who has come from a distant city checks him out. He obeys the gentle instructions. Raises his hands. Tentatively at first, grimacing at the pain. As the pain eases, a smile breaks through his white moustache and beard. As the testing and relieving continues, there is unceasing chatter, a lot of good-natured teasing between the patient and the doctor.

The wheelchair handler is called in to understand the doctor’s instructions. Soak his legs in hot water before he goes to bed. As hot as, and as long as he can bear.

As the doctor departs, so does the delivery guy from a grocer, who had been inside, stacking up stuff.

The old man puts down his cup and resumes the story he was telling. Another trip down memory lane. Like the sun filtering through the leaves in a gentle breeze, dates and names are now bright, now in shadow.

The maid signals the guests not to make him talk until he finishes the tea. Else he would again forget to sip. Again, she would have to reheat.

He tells her to shut up and go away. She does just that. Keeping an eye on him but away from his eyes. She takes her time to respond and come to him when he calls her again. There is no malice. He is smiling. So is she, despite the sulk mask.

No one who has interacted with him so far is related to him. Yet everyone around in the community is his family, tightly bound.

By ownership, he ought to be alone in that grand old house. Someone or the other, from near and far, always ensures he is not.

He is wheeled out, shouting out instructions for yet another get-together in the evening. The dogs waiting outside can barely contain their jumps and wags of glee.

The clock ticks on as if urging the lizard to get a move on. It remains where it was.
​
Tomorrow, more will come. So will more laughter.

She chose hand surgery because she could perform that sitting, confined as she was to her wheelchair. The Sitting Surgeon would go on to give wings to many.

Dr Mary Verghese was keen to study obstetrics and gynecology. An accident shattered her dreams and left her a paraplegic. After that she underwent multiple excruciating surgeries so that she could get better at being a surgeon, who could not stand.
​
In Take My Hands Dorothy Clarke Wilson tells The Remarkable Story of Dr Mary Verghese of Vellore. Here are some extracts from the book that reveal what a struggle it was for Dr Mary to recover from two spinal surgeries.

​The [first] fusion operation was performed on March 14, 1955. Bone chips taken from her hip were inserted between five lumbar vertebrae, in order to effect rigidity.

[After the surgery] body encased in two slabs of plaster, either one removable, Mary was again placed on a revolving bed. Twice each day she was turned. In the morning, the nurses would remove the top slab and bathe her. Then, turning her over, they would remove the other slab and bathe her back. For two or three hours she was left lying face down. The back slab was then replaced, and the bed turned to leave her again lying on her back. The procedure was repeated in the evening.

It was for the hours of greater freedom twice a day, lying on her face, that Mary lived. Head taped and pillowed, a book lying on a low table below the open bed frame, arms resting on the table, she could read or study. Avidly she read book after book [including] volumes on the causes of nerve paralysis.

Immobile, widening horizons
Not that the longer periods on her back were wholly wasted. She used them to pray for other people and to strengthen her own spiritual life. She enjoyed the visits of her many friends. She shared the problems of students and nurses, listened eagerly to news of all the latest romances and even tried to promote a few.

Friends brought flowers every day, and one doctor even fixed a pot of blossoms under her bed so she could see it when she was lying on her face. Dr. Rambo, the American eye specialist, brought a travel poster of the Jungfrau and fastened it to the wall. 'You need something to widen your horizons,' he told her with a smile. 'This will help.' It did.

How it did! It stretched the walls to include unbelievable vistas. The pinnacle of whiteness was like a glimpse of heaven.

Reflecting life around
​Nurse Effie Wallace, as ingenious as she was practical, had attached a mirror to a bar over Mary's head, reflecting not only her face but the trays of food set on her chest, so she could feed herself normally, with her fingers. Even better, the mirror could reflect objects outside the window: the big tree, a bougainvillea bush, people passing along the path towards the leprosy clinic.
​
The second operation was for fusion of her lower thoracic vertebrae, utilizing bone chips taken this time from her leg. Back in her room, Mary began again the weeks of immobility and waiting: the imprisoning slabs of plaster; endless hours on her back; the two shorter periods of respite each day on her face, the open book on the low table beneath her, the pot of flowers a splash of brightness on the bare cement floor; the cheering visitors; the young nurses and student doctors dropping in for advice and gossip; the praying for the needs of others; the sounds of hurrying feet; the reflections of a tree, a garden, striding figures.

[Some years later, the aircraft was ready to take off as Dr Mary returned after her Fellowship at the Institute of Physical Medicine and Rehabilitation, New York.]

The doors were closed, the seat belts fastened. The great plane began to move clumsily towards the runway, like a bird out of its proper element … or like a human being intended to run on swift limbs but doomed to lumber on wheels. It came to a stop, shuddered as if in mortal agony, then with a roar burst its bonds, mounted upward into freedom. Mary felt a kindred surge of triumph. She saw far below a huge city shrunk to incredible smallness, a blue expanse dotted with toy ships, then nothing but sunlight and clouds and infinite skies. She closed her eyes in wondering gratitude.
​
I asked for feet, she thought humbly, and I have been given wings.

​These days there are so many World Days. Insert a word between World and Day and there! Not all those days matter to all. Except for some. Like today.

Today, October 8, 2022, is World Hospice and Palliative Care Day.

Palliative care is the branch of medicine that is about care beyond cure. It helps one live in pain-free comfort, with dignity, until death. And offers solace to the family that must live through the dying and beyond.

That may make more sense if you or someone dear to you is suffering. Or is dying. When the only hope left is for some quality of life (some peace, no pain, sufficient comfort, dignity retained) until life breathes. Quality of life is something that matters to all of us in every stage of life. Most so in the last stage.

I am fortunate to have two friends in professions that work to provide quality of life in different ways. Dr Priyadarshini Kulkarni is a palliative medicine specialist and the founder of Ease and Comfort. Lovaii Navlakhi is a certified financial planner and transitionist, and the founder of International Money Matters. 

What has money got to do with palliative care? Or with quality of life when you are in no position to earn?
​
We will let them answer. 

​Dr Priyadarshini Kulkarni
“I know a family that has just two aging parents at home. They have multiple problems and are totally dependent on others for every little thing. They prefer to be at home. Among an array of people employed to help them is one person whose only job is to be with them and keep an eye on them. This person has no training as  a caregiver. Yet, this help alone is costing them more than ₹50,000 every month. Imagine the total spend! How many families can afford that?”

Lovaii Navlakhi
​“When we think money, we tend to focus on the quantity. The more we have, the happier we feel. I think what is more important is what your money is doing for you. Is the quantity of money you have giving you the quality of life you want? That is why responsible financial advisors first understand what you want to do in life, before working out the most prudent way to invest your money to help you reach those life goals.”

​Priya
“Treatment of a major disease like cancer will drain a lot of money. As dementia progresses there will be an increasing need for constant care. It is not always about palliative or end-of-life care. As life expectancy lengthens, as more and more families turn nuclear, there is also an increasing need for independent, geriatric care. It is a long wait. That does not come cheap.”

​Lovaii
​“Insurance is important, but your health insurance policy may stop supporting you after a certain age. Your best bet when you grow old is your younger self, what your younger self wisely put away all those years ago.”

​Priya
​"​In most cases, the role of palliative care is to ease pain and provide comfort. But what often hurts the most is the loss of dignity. There was a very successful entrepreneur, who was once the king of his domain. He was now helpless, terminal. He wanted to know if it was possible for me to speed up the end. What was unbearable for him was to have his wife and daughter-in-law, the only family he had at home, take complete care of him as he just lay there. He did not want to be at the mercy of others. The problem was solved by handing over all care to medical professionals. Fortunately, the family could afford that. How many of us can?”

​Lovaii
​​“Parents are so eager to educate their children, get them married and set up a home for them that they start saving right from the time their child a born. What they forget is to provide for themselves. By the time they realize that, it is too late because the cost of care is always rising. They end up being what they never wanted to be—a burden on their children.”

​Quality of life can mean different things to different people. Even for the same person, it can mean different things at different times as life goes through its inevitable phases and transitions.

We do not want to talk of death. Nor are we comfortable talking about money with family. We cannot escape either, death or money. Between the two, why not plan the reality that we have more control over—money?

Palliative care helps you live as well as possible until you die. And it preserves dignity by respecting one’s life till the end. Financial planning can facilitate this, for oneself and for others.
​
Maybe it is time for a couple of name changes. Let’s change financial planning to life quality planning. And let us celebrate today as World Quality of Life Day.

Please visit 
World Hospice and Palliative Care Day 2022 (thewhpca.org)