His Last Pongal on his feet.

The OPD nurse carefully arranged patient case-sheets into a big, wobbly pile that barely held together, as if playing jenga with them. That is when you know that you will miss lunch on OPD day.

Each case-sheet represented a sick person who was waiting to be seen. Each file had its own story of suffering to tell. The shaky bundle was an assortment of tales of woe.

The exceptionally old gentleman at a junior resident’s table had limped in, supported by his wife and his son on either side and holding the hand of a very worried grandson. His grip was weak, like his legs, but he held onto this small hand with steely resolve.

He spoke in a strained staccato, as if he was being choked and could only get a few words out. His wife and son had to narrate his story in his stead. His family looked on with contained apprehension, as his arms and legs were flexed, extended, and hit with a tiny hammer. The ordeal must have seemed strange to him, but he complied without a word. He stole a few affectionate glances at his podgy grandson whenever the doctor paused his examination.

The diagnosis was clear, it was Motor Neuron Disease (MND), a devastating neurological illness that slowly seeps away the strength from your muscles. It usually starts with your limbs and ends when the muscles that pull air into your lungs die.

A “worsening illness of the nerves that cannot be cured” was how the resident put it. The gritty details of an illness with definite murderous intent are often broken slowly, but in between the doctor’s words, death sat in plain sight.

The grandson’s face was the first to droop. The worry in his face budged and gave way to a deep sorrow that pooled in his eyes. The wife, the son and the doctor couldn’t meet his eyes, now that they knew he was dying.

The old man’s sunken cheeks seemed hollower and his frame meeker than a few minutes ago, but the calm in his eyes did not flutter. I hope that when my time comes, I welcome death with half the grace and a quarter of the courage this wise, old, uneducated farmer showed. He had accepted the inevitability of his death casually, like how one accepts leaves falling in autumn.

He huddled to one corner of the room with his wife and gathered their belongings in preparation for his stay in the hospital when he felt a tug at his shirt.

“Thatha*, won’t you be home for Pongal**?”, the boy had red eyes pouring out streams of tears that snaked over his chubby cheeks. The old man looked at the doctor, the calm in his eyes muddled as tears welled up. Suddenly, there was one more thing he wanted to do before he passed.

Without a cure, the intention of an MND admission is at least partly to teach medical students about the disease, besides palliative care.

We decided that both could wait one more week, until after he had enjoyed his last Pongal on his feet.

*Thatha – grandfather

**Pongal – Tamil New Year festival celebrated by cooking a rice dish, also called Pongal.