By Peter Ronald Desouza
March 17, 2015
The picture of hundreds of people lining the road showering marigold petals on an ambulance as it sped past on an empty road in Vijayawada, during daytime, brought tears to my eyes. I was puzzled by this strange emotion, unprepared for the tears welling up within me however fleeting they may have been. To see hundreds of people showering marigold flowers on an ambulance, led by a pilot car whose siren announced the urgency of its purpose, was difficult to explain. Something very special was taking place, something the people seemed to collectively understand and endorse. With their marigold flowers, they had come to salute and confer a sacred status on the passing ambulance. In it was the heart of a young man who had just been declared brain dead and whose family, after a brief period of counselling, in a supreme act of humanity, gifted it to another human being. For someone to perform such an act of humanity, at a time when they are struggling with the pain of loss, is an act of transcendence that only the gods can understand. And perhaps even they cannot.
Of Collective Will
V. Raju’s photograph, alongside an article by P. Samuel Jonathan titled “Brain dead man gives life to 8 people” (The Hindu, March 7), clearly moved me. It seemed to touch something deep within and I felt the need to comprehend not just the tears but the whole episode since it contained more than just a personal emotion. Was it the sense of humility that the story produced in me when I reflected on the gesture of a sister donating the heart of her loving brother to a complete stranger? Was it some deeper understanding of the meaning of life that she had, or perhaps some spiritual feeling of human oneness, that produced such a selfless act? Was there no anger at life’s irony that another can live because one’s loved one has died? Or envy or even self-pity? Where did these emotions go? Did the sister see, in the gift, her brother living on? While that seems a credible explanation, the gesture in fact says much more. Saving the life of another also appeared to count. I wondered if I was humbled by the spectacle of the “collective will” in action as people stepped out of the path of the ambulance, and waited on the side of the road so that it would not be delayed even for a second. The marigold petals being showered on a heart that was not beating, but that contained the gift of life, had something metaphysical about it. I needed to pursue these thoughts a little more.
I did a Google search with the words “green corridor for heart transplant” and was amazed at the stories that appeared on my screen. Chennai, Bengaluru, Vijayawada, Hyderabad, Hearts donated by grieving relatives, harvested in one place and taken to another to bring relief to an anxious family. A heart carried from one hospital to another, in Chennai during peak time, in 21 minutes on a route that normally took more than an hour, ending in a successful transplant. A heart being airlifted from Bengaluru to Chennai in record time to save the life of a woman whose own heart was fading. From the Internet, one read of many cases, within a city, and in some instances across two States, as families, counsellors, hospitals, doctors, ambulance staff, airport authorities, aircraft crew, city authorities, police and the commuting public, cooperated to make the heart transplant a success. The green corridor worked. And just as I was preparing to formulate a thesis about the superior civic virtues of the emerging new public in the South of India, of the South’s expressive humanism — since the numbers were coming mainly from Bengaluru, Chennai, and Hyderabad — I read in early March of a similar green corridor which was successful in transporting a heart from Gurgaon to Delhi. It was clear that the time had come to look at the many elements of this new humanism.
The first is the counsellors at the hospital who assist the grieving relatives to bear their loss and also to think about allowing the cadaver to be harvested for its organs so that another can live. This requires not just courage, but also deep empathy, to approach a family in the middle of its sorrow and to ask its members to consider the donation of the heart of the loved one, who has just been declared brain dead, to another. For the family to give up the hope that the loved one will live again, to accept death, and then to think about a gift of the heart to another is an act of spirituality that every priest, of every religion, must talk endlessly about. The counsellor’s job is perhaps the hardest in the world. Yet, some people opt for it because of a commitment to humanity. The families of the deceased, in their act of giving, display a quality of sprit that can both humble and elevate us. Many Vipassana camps may not be enough to comprehend the enormity of the gesture.
The System’s Response
The second aspect is the hospital authorities and the relevant government body tasked to ensure that the organ donation and transplant are legal. The emergence of a system which ensures that the donation is without coercion or inducement, which coordinates with the various hospitals involved in the transplant, which maintains a database of needy patients so that various persons can benefit from the donation of multiple organs, which communicates the possibility of such a donation to the receiving hospitals, which does this in a short time frame, since time is of the essence, in other words a system that removes all the constraints for the transplant to be successful, is a system that we must salute.
The third element is the police and the city authorities. It is easy, as is often the case with government authorities, to negatively respond to a request by enumerating the many obstacles that lie in its way. These may relate to rules, or to delivery logistics, or to social behaviour. Born from years of habit, the immediate response of a government official, to an unusual request, is to deny the granting of it. Such negativity is easier to live with since it is a no risk strategy. So, suddenly to witness a different response from the police and the municipal authorities who prepared and imposed a “green corridor” on the travelling public — where all the traffic lights on the route to be taken by the ambulance carrying the donated heart are kept green and all other lights of roads leading to the corridor are turned red — is again a response by the government that can only be applauded.
The fourth aspect is the effort of the ambulance and aircraft crew. Reading the reports, one got an idea of their sense of purpose. As one driver stated, after a particularly tense drive, carrying a heart from one hospital to another in the same city, was for him the drive of his life. Also, of another life. For him, the anxiety of not succeeding, of letting down the patient waiting for the heart, of dealing with the uncertainty of driving at speeds in excess of a hundred, on an Indian road, where a dog or a cow or a child may suddenly cross the road, despite the best efforts of the police, was an anxiety that had to be endured. Many people across some Indian cities have risen to the challenge and delivered a healthy heart from one hospital to another.
The fifth aspect relates to the doctors and nurses at both ends, those who remove the heart from the cadaver and those who prepare the receiving patient for the transplant. They have to believe that it will be delivered, that the system will work and that they must play their part in the long chain of success. The receiving team has to check all parameters and keep the patient operated and ready. For all of them this is not business as usual but a commitment to the Hippocratic oath of saving a life. The numbers of such doctors are growing.
Expression of Fraternity
The final element is the public waiting for the ambulance to pass. Patiently. Respectfully. Such publics have emerged across many cities in India. Spontaneous publics moved by a higher purpose than just self-interest. It is the first light, I hope, of a new India. What seems so natural in the picture, of people lining up at the side of the road to let the ambulance pass, is actually quite extraordinary. In the picture we see hundreds of people suspending their self-interest, and instead of rushing home to do their personal work as they would on a normal day, willingly waiting by the side of the road for a heart to pass. Can we read in this behaviour their subscription to an idea of the public interest and the common good?
Let us now look at all these elements together. There are no caste, community, or gender biases here. None of India’s prejudices can be seen in this act of giving life to total strangers. What we see instead is the other as part of the self. How different from the politics of today where the other is regarded as a hostile other, to be hated and excluded from our public life. Will this expression of fraternity become a movement and replace the politics of hate that is today being sown? I remember reading, several years ago, of an elderly upper caste gentleman in Bengaluru who had been hit by a car when on his evening walk, who wept when he had been told that the person — who had travelled many miles on his scooter at night, after the hospital had called the latter and asked him to donate his blood belonging to a rare group — was a gentleman who belonged to a community that he had maligned all his life. The old man wept for a wasted life. He wept for his smallness of spirit. My thought train, which had started when I saw the picture of people waiting for the ambulance to pass, now continued. Why is it, I wondered, that we can receive blood and a heart from another, without worrying about caste, creed or gender, but we cannot wear another’s skull cap?
Peter Ronald deSouza is Professor at the Centre for the Study of Developing Societies, Delhi