Tag Archives: loss

Why Indian Immigrants Are Facing a Unique Wellness Challenge

As America celebrates the loosening of the mask mandate, on the other side of the globe, there is a contrasting scene unfolding, complete with doom and gloom. Since April 2021, India has been battling the second wave of Coronavirus. Mass funerals, new variant reports, vaccine shortage, and an overwhelmed healthcare infrastructure are the new themes in the Indian media outlets. 

Whatsapp is abuzz with concerned messages from loved ones as well as news of losses and hospitalizations. Social media is brimming with not only political whodunnit analyses but also generous fundraising efforts.

Stories abound on how nepotism and bribery came to the forefront, especially when procuring a hospital bed. While in the same thread, we hear heart-tugging stories of kindness and sacrifices, where the human spirit has triumphed.

If you are an Indian immigrant living in the United States with family back home, then you are likely living the nightmare you have always dreaded – that late-night call. 

The fear that you are unable to be there for your family during their darkest hour.

The survivor’s guilt has possibly reached its peak within you. 

Neeta Jain worries in the US about her family in India (Image provided by Author)
Neeta Jain worries in the US about her family in India (Image provided by Author)

 The visa limitations due to outdated immigration policies and the newly imposed travel restrictions further exacerbate the situation for some immigrant families.

Indian immigrants are experiencing high levels of anxiety right now. Some are grieving, some are feeling helpless or guilty. The impact these emotions could have on their health and wellness is unimaginable. Especially given the always-on work culture in corporate America. 

As Indian immigrants continue to power through Zoom meetings, work deadlines, and deliverables, there is little empathy shown in most Corporate American settings. There are not enough conversations about the toll this second wave is taking on the wellness of Indian Immigrants in the United States.

The anxiety attacks. 

The sleepless nights.

The emotional eating disorders.

The survivor’s guilt, which is probably the hardest to reconcile.

While we continue to hope for the situation in India to improve and demand immigration policy reforms, here are five things we can do to take charge of our well being right away:

PLAN A FAMILY ACTIVITY: While our families are in lockdown in India, create a simple daily or weekly activity together, where you and a family member are bonding. Here is an example for inspiration. Bring out a new book and write down recipes from your mother, father, grandmother, or sibling. And even attempt cooking it! Food is love and food is nostalgia, and hence a powerful medium to stay connected. Also, most family recipes are hearsay and rarely documented in a structured format. So this will be a prized possession for years to come!

FOCUS on BASICS: Sleep & hydration. During extreme moments of anxiety, insomnia could surface for some of us and sleep quality and quantity may be negatively impacted. In addition, watching our water intake could take a back seat and we could be hydrating ourselves poorly. When you are going through a rough phase, it is best to keep things simple and focus on basics i.e. Sleep and Hydration. Moreover given these are emotional times, our food cravings could also come back with a vengeance. Maintaining good sleep hygiene and staying hydrated will help with those food cravings too.

GET GROUNDED IN NATURE: With the weather warming up in the northern hemisphere, getting out in the sun and soaking in the abundance that nature offers, will help destress and calm those nerves. Also, feel empowered to take a social media break, a news break, or a complete digital detox to reconnect with nature in any way that feels most aligned with you.

GRATITUDE JOURNAL: It has been hard to stay positive for even the most optimistic person in the room. And hearing for the nth time “Stay positive” or writing affirmations may neither be effective nor helpful right now. But having a gratitude practice, especially in the form of a journal can be transformational. When you bring paper and pen together, the brain is able to process the emotions a bit better, especially those of anxiety and grief. Write 3 things every morning that you are grateful for before you get immersed in the daily grind (Note: this can be the littlest thing!).

FACE THE GUILT: Lastly and likely the most challenging, as facing the Survivor’s guilt requires a great deal of vulnerability. Becoming aware and acknowledging this guilt, which may be wrecking those who have had losses amongst their families or friends is hard. Moreover, there is still a fair bit of stigma around getting help from a therapist or a counselor in the South Asian community. However, try and step beyond that stigma if you can and get help from a licensed practitioner to process this guilt.

Neeta Jain is a health coach and the founder of Her Shakti, a wellness company that helps immigrant women transform into their healthiest, strongest selves. Go from overwhelmed busy bee to nourished goddess with her free tips.


A Memory, 2020

My best memory from 2020 isn’t necessarily my happiest. This year I felt no simple, one-note emotions. And so my best memory is one that encompasses the complexity of a harrowing year, glutted with loss. 

I returned to India at the end of December 2019 after a ten-year absence. On New Years Day I was in Chennai, after the drive from my family’s home in Pondicherry. I brought my three children along for this trip, now pre-teens and teenagers. They were toddlers on our last visit. 

Sunset in Pondicherry - Image taken by Author
Sunset in Pondicherry – Image taken by Author

As we drove from Pondy to Chennai, I devoured every scene of this country I’d missed for nearly a decade. The thatched huts, the overloaded lorries, a family standing in impossibly green grass, flanked by their taciturn cow. A woman posing for a selfie on the side of the road while balancing a great steel pot atop her head. Coconut groves, rice paddies, pilgrims wearing red saris that matched the blazing flowers on the nearby Poinciana trees. 

I went to the temple on New Year’s Day. Our driver guided us through a maze of people, thousands of them, a fact I can hardly contemplate now. That profusion of humanity is something I love and miss about India, and it’s one of the cruelest aspects of this pandemic—the inherent peril of India’s ubiquitous crowds. 

But at the beginning of this year, I could relish the throngs. What a different world it was.

Past the entrance of the temple, people waited in line to see the various deities. They pushed and complained, or fanned themselves with folded newspapers. Our driver presented an inscrutable, flimsy paper enabling us to advance in the queue. 

I stood at the front of the line, ready to receive my blessing, when an old woman, no higher than my elbow, strong-armed her way through the clot of people, shoving me aside. I let her pass. She was cracked and broken-earth old. And beautiful—in India such advanced age deserves reverence. 

In creative writing classes, instructors often advise us to “tell it slant”, a concept denoting the odd and intriguing detail that makes a story memorable. On this trip to India—my last real trip of 2020–the entire visit felt “slant”. From my uncle’s hilarious stories to the old woman at the temple, to the rickety stand on Marina beach selling dubious curry shrimp pizzas. 

Our prayers finished, I made my way back to my shoes, left outside the temple entrance. It had rained, and puddles collected on the uneven pavement, slimy on my bare feet. An old woman implored me to buy a garland of jasmine flowers. Another hawked damp, battered children’s books. 

As I exited the temple and approached our car, oblivious to what awaited us all just a few weeks away, I noticed a tiny, emaciated stray kitten, shivering as it crawled to one of the puddles. It lapped up the fresh rain. I wished I could hold the kitten in my hands. I doubt it survived more than a few more days.

But the image of that forlorn creature stays with me, slant indeed, and painful. In this year, so thick with loss and missing, I feel a kinship with that poor animal, stumbling forward, searching. When this is over I will have lost three semesters’ worth of connections with my students, along with the birthday parties, dinners, and the celebratory plans I had for my debut novel’s publication. 

And then, just weeks ago, the worst news of all. I lost my beloved uncle—the one I’d just visited in India for New Year’s. None of us could say goodbye to him. He could not even die in his hometown because the ICUs in Pondicherry were full. 

I often think the world provides me with poignant images that have little meaning for me in the present, but are planted in me to decipher later for some future lesson. And indeed, throughout this year my mind has returned to that kitten—now gone, I’m sure—because I feel so much like that creature these days. Stumbling forward, relentlessly aware of my fragility, but still grateful for whatever reprieve life offers. And sometimes, that reprieve is memory itself—of a time when life was easier and less freighted by loss. 

The pandemic will be over, and hopefully soon. I will return to India. My uncle will be gone, his flat in our family house empty, and I will be consoled instead by the palm trees and mangroves, frangipani flowers, bougainvillea, and other Pondicherry flora in which my Botanist uncle delighted.  And I will think back on that kitten, that New Year’s Day, when fragility belonged to something else, and not to me, or us.

Samantha Rajaram is the author of the novel THE COMPANY DAUGHTERS and lives in the Bay Area. 

Bereavement in a COVIDian Era

I stood anxiously inside the ICU while my brother spoke to the doctor on duty to confirm that his report explicitly stated that our mom’s death was non-COVID related. Without that report, we had been told that we would run into issues with the city. My brother scrambled to get the report of the COVID-19 test that was taken a few days ago while our spouses tried to book the earliest slot in the crematorium to minimize contact with other mourners. My mom had just died after a five-week struggle in the hospital but dealing with the pandemic took precedence over our grieving process. 

As condolence messages started pouring in, a common thread ran through them: “How fortunate that you got to spend the last five months with your mom!” “You must be so grateful!” “The COVID-19 lockdown was a blessing in disguise for you.” “You’re so lucky.” I thought I heard a note of jealousy in one octogenarian’s voice but soon I realized it was just fear: “Your mother was so blessed. How lucky she was surrounded by her family!” Another message sounded very bizarre when I first heard. “You must be thankful that she did not die during the lockdown. We could not scatter the ashes of my father in the river Cauvery because of travel restrictions.” Rarely, these messages and conversations dwelt on my loss or my grief. 

In February, when the Coronavirus infections were still in single digits in Silicon Valley, my mom was hospitalized in Bangalore and I left for India. My mom came home after a few days. I had a return ticket for a date in March but my instincts were against returning to the US. Then India went into a countrywide lockdown, and all international flights got canceled. I got to spend the next five months with my mom, taking care of her, listening to her desires, her fears and her view of how her life had fared. We played cards, listened to music and discussed recipes.

Anandi’s mother on her birthday.

During this pandemic, some of my friends in the US lost their loved ones in India and were unable to attend the funeral in India. Some in India were also unable to travel to the funeral of their loved ones. There are so many obstacles: lack of flights, travel restrictions and quarantine rules. One friend had to ask a neighbor to take care of the funeral of a loved one. The most harrowing ones I heard were from people who lost their loved ones to COVID-19 and did not get to say their final goodbyes. There were sons who could not perform the last rites. A friend, sobbing uncontrollably, told me that she did not get to bathe and dress her mother, a daughter’s duty after the mother’s death. This coronavirus has not only killed people and financially ruined many but also has left survivors suffering from guilt and having trouble getting closure. Hence, I do understand the significance of the condolence messages I received. Besides getting time to spend with our mom, my brother and I got to do our last duties, which have become increasingly challenging during this pandemic. 

It has been a few weeks and I am home now. Some nights I wake up in a state of panic, struck by the finality of my mom’s death and it feels like someone is sitting on my chest. The other day, when I was sitting at the dining table, I thought my mom would have liked to know who brought us food on the day of her funeral, since cooking is not allowed in the house. That is the kind of question she would have asked me and I would have told her that someone whom she cared about deeply brought us food. As days pass by, often I find something I would have shared with her – a recipe or a song by a rising young singer or a visit by a friend or a relative — on our regular weekly phone calls and I grasp the impossibility of communicating with her and have trouble breathing. I feel the vacuum in my life. None of the positive things people said comfort me. Grief does not care about logic and reason. I have lost a relationship, the longest one of my life, and I do not feel fortunate. 

Anandi Lakshmikanthan is a retired software engineer. She is a co-founder of Sevalaya USA. She tutors refugee women and children. She has written short stories and reviews. 

Teenagers Use Technology to Fight Dementia

Brainy Haven is a nonprofit created by high school students from Huron High School in Ann Arbor, Michigan. Its founders, Raayan Brar, Darron King, and Siddharth Jha, worked collaboratively on the initiative after realizing the lack of online resources for not just the elderly, but specifically those with dementia-related illnesses.

“In the modern world we live in, using technology to better those around us is our obligation,” says Jha. “At Brainy Haven, our team hopes to serve those with dementia-related illness by aiding their process, which can be terrifying for many families.”

Brainy Haven aims to assist those with memory through the use of technological resources. Their website contains an assortment of puzzles and brain teasers for dementia patients to use, ranging from patterns to a fully functional memory game. Having already sent it out to many nursing homes, the team at Brainy Haven has received positive feedback from users.

However, wanting to do more, the three contacted a team at the University of Michigan Alzheimer’s Disease Center to receive feedback on structure and implementation. “I had known the Alzheimer’s Center’s Director, Dr. Henry Paulson, from past events so it seemed like he’d be the perfect person to reach out to for help,” King explained, “Dr. Paulson kindly introduced us to a group of people with diverse skill sets working at the Center and they gave us some detailed, brilliant feedback.”

In addition to Brainy Haven’s carefully crafted program, users can find important information regarding dementia-related illnesses and their impact on the brain. The team was astonished to see the sheer number of people affected by dementia and they hope that through Brainy Haven, those who are lucky enough to not have been afflicted with dementia can take a few moments to educate themselves on what dementia really is and its effects on their communities.

Brar remembers reading an article from the Hindustan Times and being shocked at how many Indians that are personally affected by this devastating issue.  “Helping the community during difficult times is an amazing thing to do,” Brar says, “I have always wanted to better society, and what we did is something so simple, but I do believe that it can help the lives of our seniors.” The trio is proud of the work that they had done, and now they want teenagers all around the world to do something similar and help benefit their community in some small way.

Sticking to their roots in India, Jha and Brar plan on sending out customized programs to homes in India. Both having had family affected by dementia-related illnesses, the two are aiming to help those suffering in their ancestral lands. “After talking to family members and visiting India numerous times as I child, I hope to be able to give back to the people of Bihar and others who have not been blessed with the same opportunities as myself,” says Jha. “Brainy Haven is the first step to accomplishing that goal.”

Siddharth Jha hopes to change the world and solve global problems through management and technology. When he is not coding, Sid can often be found playing a game of chess or partaking in any other strategic activity.

Raayan Brar passion in life comes from the joy of teaching others and helping the community. As a teacher at various student programs, Raayan knows and enjoys the true value of critical thinking.

Darron King is planning to pursue a career in the field of neuroscience and psychology in his future endeavors. He is interested in learning about the endless capabilities of the human brain and is excited about the future of neurology.

A Daughter’s Prayer

A Ray of Light enters my Heart

And I know it is You

A Constant Source of Love and Care

My Whole Life through


A Shining Path for us to follow

Your Footprints will never fade

Oh Heavens Rejoice, your Loving Son 

Restored to your Grace


The Sun has set, and risen again

Another day has dawned

Time does not wait, Life moves on

But you will Shine on


A Noble Soul, whose gentle wisdom taught us all

In matters big and small

Sweet Memories circling in my mind

With laughter and tears, through it all


A Life of Truth, Beauty, Courage and Joy

Extraordinary Scientist, Mathematician and Artist Combined

Reunited with Blessed Parents, Wife, Daughter and Sister

Your Soul Soars Free, in the Divine


In Memoriam
Dr. Sundaresan Naranan
Survived by his 2 daughters Venil and Gomathy, and 2 grandchildren Ashwin and Amrita
April 17th, 1930-November 28, 2019




My Sweet Love: A Remembrance

Just three months have passed since you slipped away leaving Ashok and me behind; yet it feels like an eternity.  I recall that summer evening vividly and with disbelief. Sitting at your bedside, holding your hand and watching as your breaths got weaker and further apart.  Then with that last breath – a small sigh – you were gone from our midst. Your face turned ever so slightly and the rays of the evening sun streamed through the bedroom window gently lighting you in peaceful repose. No more pain. No more suffering. No more medication. In the lap of Mother Nature and the Almighty for eternity. We are left behind to bear your loss, mourn your passing. We struggle to live on and cope without you, without your strength, your grace, your spirit, and your love to hold us all together.

These three months have been surreal. I’m sure I will wake up from a dream any minute now to a sound you’ve made, and check if it’s time for your morphine, monitor the oxygen flow, give you a sip of water, and adjust your pillows.  But that’s the dream – that you are still here, with us a while longer, smiling through your pain and discomfort; a tower of strength, showering us with your love, the gentle touch of your hand in mine and peace in your heart.

The first few weeks were a blur.  I recall our neighbors stopping by with food, sympathy and offers to help. Bhaiyya, bless him, stepped in and took care of the funeral arrangements.  All our friends said kind words. Ashok and I moved around in a daze, unable to fully comprehend that you were no longer with us. Then there were arrangements to make, questions to answer, calls to banks and credit card companies and insurance companies, forms to be filled out.  I threw myself into these distractions. 

Eventually everyone returned to their own lives. The new school year started and Ashok is back in class – eighth grade now – and seemingly doing well. He has signed up for track and field and goes for practice a few evenings a week.  I am back at work. We are getting through our daily routines. He and I watch a ball game together on weekends and I make dinner for us most nights. We go for walks once in a while and run errands together. We don’t talk much about what happened; there is a lot that is left unsaid.  Remember our picnics in the backyard? He and I tried that last weekend but it just wasn’t the same.  

The hospice folks have been great. The social worker stops by or calls to make sure Ashok and I are doing okay.  The other day she recommended that we try joining a support group for families or sign up for grief counseling. I don’t want to sit and listen to a bunch of people talking about people they’ve lost or about their difficulties coping.  I’m not sure I can handle that. 

All told I think I’m doing okay and handling myself the best I can.  However, little things – random thoughts, a place, a phrase overheard, or the sight of something – suddenly trigger uncontrollable grief.  Just one toothbrush by the bathroom sink. Your blue dress hanging in the closet. That tree in the park that you liked so much. News of some new breakthrough in cancer research. I never know when it’s going to happen and when it does, I don’t know why. It just does.  There are days when I hear myself talking out loud to you as though you are in the next room, about to walk in at any instant. All your things are just where you left them. I don’t even want to think about what I’m supposed to do with them.

I cannot believe you’ve left us. I become numb thinking about it. I keep going back to that day in February when Dr. Jeffries told us that continuing treatment was no longer a practical option.  Sometimes I feel that they gave up on us too soon. Couldn’t they have tried another approach? Perhaps there was a clinic somewhere else that could recommend a treatment that would work? Agreeing to turn to hospice care felt like admitting that we were at the end of the road. Should we have looked at other options?  It makes me angry sometimes. I feel like throwing things. And then I think of what you said to me: “I want to spend my last days in the comfort of my home, with the two of you, in peace.

Asha, you give me the strength every day to move on. I think about our lives together and how we managed to get through all of this, and I’m hopeful. Some days are better and some days are worse. I wake up early in the morning sometimes and lie in bed wondering how I’ll get through the day. Why did you have to go?  How will life be for Ashok and me? Will I be able to do the right thing by him? Be there for him? Will he know that he can come to me for help? Then I always ask myself what you would say and I have my answer.  

You are with me all the time. In my heart. Perched on my shoulder guiding me at every step, giving me courage to get through the day.  I am so thankful for you, for Ashok, and for our time together. My sweet Asha. My Sweet Love. I miss you terribly.


Your Arun


This remembrance is dedicated to all those who are left behind grieving for their loved ones.


Mukund Acharya spent 40 years on three continents as a professor, scientist, manager and technologist in aerospace. He currently promotes healthy aging and wellness, advocates for patients and their families, and is exploring the use of short stories, photopoetry, and blogs to spread the message on the importance of living substantive, impactful, fulfilling and contented lives while giving back to the community.


Tax Cuts and Jobs Act (TCJA) Changes For 2018

Major tax legislation at the end of 2017 has suspended many prized deductions for 2018 through 2025, while cutting tax rates. Here are the details:

Altered and eliminated tax deductions

  • Personal exemptions. You can no longer count on personal exemptions, including dependency exemptions for children and other relatives. They are eliminated.
  • State and local tax (SALT). The deduction for state and local tax (SALT) payments is limited to $10,000 annually.
  • Mortgage interest. Mortgage interest deductions are modified, including eliminating deductions for home equity loan payments…unless funds from the loan were used to build, buy or substantially improve your home.
  • Miscellaneous expenses. The deduction for miscellaneous expenses, including unreimbursed employee expenses, is eliminated.
  • Moving expenses. Deductions for moving are eliminated (except for military personnel).
  • Casualty and theft loss. Casualty and theft loss deductions are eliminated (except for losses in federally declared disaster areas).

Enhanced tax deductions

  • Standard deduction. The standard deduction was nearly doubled to $12,000 for single filers and $24,000 for married filing jointly for 2018.
  • 20-percent business deduction. A new up-to-20 percent deduction is allowed for qualified business income (QBI) of pass-through entities, including sole proprietors.
  • Child Tax Credit (CTC). The Child Tax Credit (CTC) is doubled to $2,000 (with a maximum refundable amount of $1,400) per qualifying child.
  • Medical expenses. The threshold for deducting medical expenses is lowered from 10 percent of adjusted gross income (AGI) to 7.5 percent of AGI for 2018.
  • Alternative minimum tax (AMT). Favorable modifications apply to the AMT calculations, meaning far fewer taxpayers will be affected.


REMINDER: Rules have changed for these five tax breaks

New tax legislation provides numerous tax benefits for individuals for 2018 through 2025. But not all the changes are likely to align with your go-to tax strategy from previous years. Here are five big tax breaks that could leave you with a tax surprise come April 2019.

State and local taxes: The new tax law limits the deduction for state and local taxes (SALT) to $10,000 annually. This includes any combination of property taxes AND income or sales taxes.

Entertainment expenses: You can no longer deduct 50 percent of your entertainment expenses. But there’s still some leeway. According to a new IRS ruling, you may deduct 50 percent of food and beverages paid separately from entertainment like a basketball or hockey game. Also, a business can deduct 100 percent of the cost of its holiday party.

Miscellaneous expenses: The new law eliminates deductions for miscellaneous expenses, such as out-of-pocket employee business expenses. If possible, have these expenses reimbursed by your employer’s accountable plan. Generally, the expenses are deductible by the employer and tax-free to employees.

Kiddie tax: The kiddie tax continues to apply to unearned income above $2,100 received by a dependent child under 19 or full-time student under 24. But the new law puts more teeth into this tax. The kiddie tax is now based on the tax rates for estate and trusts. This generally produces a higher tax, so plan intra-family transfers accordingly.

Home equity loans: In the past, a homeowner could deduct mortgage interest paid on the first $100,000 of  home equity debt, regardless of use of the proceeds. The new law eliminates this deduction for home equity debt, unless the proceeds from the loan are used to buy, build or substantially improve your home. Fortunately, you may still deduct interest on the first $750,000 of acquisition debt acquired after December 2017.


Tax records needed for 2018 tax returns

  • Personal information: You still must provide your Social Security number (SSN), and SSNs for your spouse and dependents.  For electronic filing, you will need your CA driver’s license or state issued identification card.
  • Employment information: Have all Forms W-2 for you and your spouse. A self-employed person must report income from Forms 1099-MISC and Forms K-1, plus information for calculating the new deduction on qualified business income (QBI).
  • Child expenses: Provide information for claiming the increased Child Tax Credit (CTC) and Child and Dependent Care Credit. This may include details for a dependent care provider.
  • Investments: Include all information on various Forms 1099 for capital gains and losses (including cost/basis information), dividends and interest. Fortunately, this can often be scanned electronically.
  • Retirement plans/IRAs: Report contributions to plans and IRAs, the value of accounts and distributions received on Forms 1099-R.
  • Rental properties: This requires records of income received and expenses paid in 2018, including amounts, dates and places.
  • State and local taxes (SALT): Recent legislation limits annual SALT deductions to $10,000 for 2018-2025, but itemizers still need relevant records of SALT payments, especially for their California tax return, which does not conform to Federal limitations.
  • Charitable donations: If you itemize, you generally need records for both monetary gifts and donations of property, plus appraisals for property valued above $5,000.
  • Mortgage interest: Itemizers must have Forms 1098 for mortgage interest on acquisition debts that remain deductible.
  • Medical expenses: Collect records and receipts for medical expenses that may push you above the “floor” of 7.5 percent of adjusted gross income (AGI) for 2018.
  • Education expenses: Provide information required for claiming higher education credits, including Forms 1098-T.


Under the new legislation, you may not need records this year for miscellaneous expenses, many casualty and theft losses, moving expenses and home equity debts.

Please call, Shermin Tawni Alam of Alam Accountancy Corporation, PC at 408.445.1120 with questions about your particular tax situation.


The Phone Call From India That Changed My Life

Jet-lagged and in shock, I waited on a bright red couch in a small room labelled “Counselling” right off the Surgical Intensive Care Unit (SICU) at the Christian Medical College and Hospital (CMC) in Vellore, India. A doctor from a team of critical care specialists delivered the prognosis with an empathy that showed recognition of their patient as a person, and of me as a daughter desperate to hold on to her parent: My mother was irreversibly paralyzed from the neck down and was fighting multiple life-threatening injuries.

Twenty-four hours earlier, before I walked into a nightmare as surreal as a Dali painting, my Sunday morning had been upended by a call from my distraught sister-in-law: She, my brother and my mother had met with a road accident on the Bangalore-Madras highway. My mother had been taken to CMC Vellore without a recordable pulse. My brother and my sister-in-law were, thankfully, not in danger.

Bidding farewell

On the flight from Boston to Chennai, I prayed and pleaded with the Universe, anchoring my mother with a love that felt oceanic in its immensity. I would cradle her with fierce tenderness for the next 21 days, at first devising an alphabet system of communication along with nods for “yes” and “no” when my mother was conscious — the various tubes down her throat, mouth and nose made verbal communication impossible — loving her, singing to her, making lame jokes, telling her stories, and soothing her. And when she faded into a coma, I talked to her Self, the one with the capitalized S, recalling stories from childhood, pouring into her my gratitude. I whispered prayers and words of love as her systolic blood pressure spiked past 250 and when her heart beat dropped to 35. My hope of bringing her home where we’d sit together in the garden and hear the birds sing as I read poetry to her changed to planning her last rites the way she would have wanted. And at the moment of her passing, my one hand on her heart and the other on her head, I bid her farewell with Ramanuja Acharya’s Tirumantram.

By then, CMC had become a second home. I almost lived there – I ate there — the staff at the cafeteria gave me extra chips, the doctors let me sit for hours by my mother’s bedside, a Reverend prayed with me, nurses held me in their arms as I left the ICU in tears. Security officers, who see more than 8,000 outpatients a day, gave directions with courtesy, pharmacists were kind, and doctors served. Authority sat lightly on their shoulders.

One doctor, whom I began to think of as a friend, brought me a pair of unmatched ICU slippers, cracking a joke about two left feet. He watched the monitors carefully as I answered my mother’s unspoken questions about where she was and why, and one night he even helped push her stretcher when the hospital was short of staff. Another doctor sent out an attendant to buy me juice after I almost fainted one afternoon from exhaustion and low blood sugar.

The head of Neurology spoke to me for nearly an hour about what was going on in my mother’s comatose brain. The spine surgeon sounded heartbroken when he told me my mother was no longer moving her fingers. I’d politely ambush people walking down the corridor with stethoscopes around their necks to explain a medical point to me, which they always did with great patience. And I saw these brilliant, top-notch doctors at one of India’s leading hospitals extend empathy to everyone alike without discrimination — I had never before encountered empathy as an institutional culture.

The humanization of medicine is not just a mirror of our social character, of how we, as a society, accord value to our fellow human beings; research shows that empathy from caregivers leads to better health outcomes while reducing healthcare costs.

Findings from a 2012 study in Parma, Italy, showed that patients of physicians who scored high on empathy had a significantly lower rate of acute metabolic complications from diabetes compared to patients of doctors with moderate and low empathy scores. Research also shows that compassion reduces burnout among physicians and medical students. Almost all of us know someone subjected to unnecessary tests by doctors trying to recover costs on expensive equipment. In the case of my cousin, an angiogram was performed on her father after he had died in the ambulance on the way to the hospital. One can only imagine the plight of the poor and the marginalized.

At CMC, paying patients subsidize healthcare for those who cannot afford it. And those of us who do pay are billed at least a third less than what leading private hospitals would typically charge. Dr. Kishore Pichamuthu, who heads CMC’s Medical ICU, said that doctors are given the authority to write off expenses incurred by the poorest patients. He pointed out that people are drawn to CMC to serve, motivated by the academic and intellectual rigor, and the opportunity to develop the next generation of doctors — all of which are institution-building factors.

I asked several doctors how everyone showed such a high level of compassion at CMC. Their answer? CMC’s selection process for undergraduate and graduate students, and behavioral transference within the system.

The right fit

The 100-year-old non-profit institution has successfully developed a method of admitting students who will fit in and add to the culture of medicine as a service. “We look for character, aptitude and attitude,” said Dr. V.I. Mathan, professor, and a retired CMC director. “Our selection process is central to our culture, and to the profession to which we commit our lives.”

Prior to the now mandatory centralized common counseling for selection to medical colleges — which evaluates applicants on marks, not aptitude, as critics say — up to 45 CMC faculty members extensively evaluated potential candidates over three days. All selected students are required to serve for two years in an area of need — mission hospital, the Army, a rural slum, HIV or leprosy centers. College fees are set at Rs. 3,000 p.a. so that doctors are not driven by return on fee investment. Fees at private colleges are as high as Rs. 3 crores.

NEET, the common entrance test, is a welcome move that will hopefully reduce corruption in private colleges. A merit-based exam, it should also help standardize the quality of applicants nationally. But in the case of non-profit institutions like CMC that have a proven track record, some amount of autonomy in the selection process is not only necessary, it is vital to sustaining its culture of medical excellence, which serves as an example to hospitals everywhere.

The essay was first published in The Hindu on July 15, 2018. 

Sujata Srinivasan is an award-winning Connecticut-based journalist whose work has appeared extensively in NPR’s Connecticut regional station WNPR, Forbes India, and Connecticut Business Magazine. She currently reports on healthcare for the Connecticut Health Investigative Team (C-HIT). She can be reached on Twitter @SujataSrini