Freedom of Expression in Free India

(US-India Stats)

Dr D.S.Rao

Dr. D. S. Rao, former Editor of Indian Literature of Sahitya Akademi, has given a lecture on 22 March, at the Ohio State University, Lima, USA. The lecture was attended by several professors and students, who took keen interest and raised questions about intolerance in India and US. Dr. Rao pointed out human intolerance is a universal issue and no country is totally free from it. He gave examples from ancient to modern times. The lecture was highly appreciated. He used power point, giving basic statistics about India and US. Towards the end, he showed three controversial paintings of M. F. Husain, and analyzed different ways of looking at them. He emphasized that a great work of art can be viewed from numerous perspectives. In any case, suppression in matters of arts is counterproductive and only draws more attention. Dr. Rao spoke extempore, but we have obtained a copy of his notes, which is no substitute for his captivating extempore exposition, and reproduce it below for our readers.


This basic information about USA and India shows, both the countries have a lot in common. We tend to think that democracy, and freedom of expression, are our additions to the civilization, and the ancients knew nothing of the sort. The sooner we stop thinking so, the better, because both these ideas have been around since how long, nobody knows. Ancient Greece in the West, and ancient India in the East, had had their brush with both these ideas.

I hope you are familiar with Socrates of Greece, and know his story. He had to pay with his life, for the exercise of his freedom of expression. He preferred to take hemlock, rather than submit to the ways of his new rulers. That was about two thousand five hundred years ago, in the West. But, in the East, in India, about the same time, Buddha broke with conventional thinking, and lived up to a ripe old age, giving birth to a whole new religion in his name. The ancient Indian rulers did not give him poison; instead, absorbed his philosophy.  However, in the West, again, two thousand years ago, Jesus Christ was crucified for his mission, but his ideas outlived him and grew to be the largest religion in the world today.

That was long, long ago. Since then, there have been rebels who wouldn’t submit, and there have been rulers who wouldn’t give in. The French Revolution of the eighteenth century is remarkable, among other things, for one reason: Liberty. The words of Voltaire, oft quoted and most relevant to us today, are: ‘I disagree with what you say, but I will fight to the last for your right to say so.’ Both US and India won their Independence from the British Rule: one by force, the other not by force, but nonviolent means. And, freedom of expression is one of the freedoms enshrined in the constitutions of both the countries.

India became Independent in 1947, took twenty-nine months to draft its Constitution, borrowing freely from the constitutions of other democracies, particularly UK, and US, and, in January 1950, proclaimed itself a republic. The Preamble ensured all the citizens of the new Republic, ‘liberty of thought, expression, belief, faith and worship’, as in the US. The Article 19 of the Indian Constitution provides that all citizens shall have the right to freedom of speech and expression, subject to the usual restrictions like libel, threat to life or property.

We shall consider how this basic human right to freedom of expression has been honored by the Government and exercised by the people of India, in three areas: literary, general, and visual.

A curious fact is, free India was led by three writer-prime-ministers, for thirty-three years of its sixty. The first, Jawaharlal Nehru, was in power for 17 years. He was a prominent leader of the Indian National Congress, which had led India to its Independence. Indian National Congress is very much like the GOP of US, except that it leans toward the left. During the Freedom Struggle, the British rulers had incarcerated Nehru nine times; jailed him for nine years. Nehru used prison time for writing books. One would think that a freedom fighter, a writer jailed for propagation of his ideas, would, when he became the head of the government, uphold the writer’s freedom of expression. And this he did, in speeches. But when it came to action, he faltered, and failed the very first test.

The first literary book that was banned in Independent India was on religious grounds: The Ramayana, as told by Aubrey Menen, published in 1954. The Ramayana, as some of you may know, is an ancient Indian epic, written by Valmiki, in Sanskrit. Some consider it as the first epic ever, and its author, the first poet ever.  Aubrey Menen is a writer of Swiftian vintage, and could write a savage satire, and this he did, in his retelling of the Indian epic. A connoisseur would enjoy the humor, ponder the satire, and put away the book. But, not a religious zealot, and there are plenty of them in India, who could easily be roused by leaders, who do not read books, but demand such books be banned. And, Nehru, the Prime Minister, thought it expedient to ban the book. Let us consider the tone and tenor of the first book banned in free India. Here is an excerpt:

‘The best way to avoid confusion in thinking about the ways of human beings is, to remember that the number of the ideas that have really moved mankind is very small, and most of this small number of ideas are very simple. The difficulty is that, you and I have room in our heads for only one or two of these simple ideas at the same time.

For instance: one of the most powerful notions in the history of thought is that of the Devil. Another powerful idea is that of Nature obeying fixed laws. If you believe in Nature obeying fixed laws, and I believe in black magic, and if we both want to obtain a nugget of gold, you will go prospecting in some place, which your study of the laws of geological action has led you to believe, has auriferous rocks. I will put a lump of lead in a basin, and sacrifice a cock at midnight, on a bare mountain. You will think me, an unsavory charlatan; I will think you, an uninspired fool. Nowadays, our friends would expect you to find the gold: in the Middle Ages they would (privately) have put their money on me. Because I cannot see your simple idea and you cannot see mine, we shall not only differ in our ways of getting gold, we shall differ about nearly everything under the sun. Since you believe that if you know how Nature works, she will do as you bid her, you will be confident that if things are left to you, and your co-workers, everything can be made bigger and better and everybody made happier. I, on the other hand, believe in the power of evil and I shall say that men are wicked, and nothing will make them better, and the fact had best be faced. Your idea may lead you to discover antibiotics or nerve gas: mine can make me a great leader of men. (13-14).

And, after 276 pages of delightful humor and caustic satire, Menen gets his mouthpiece, Valmiki, conclude:

‘There are three things, which are real: God, human folly, and laughter. Since the first two pass our comprehension, we must do what we can with the third’ (276).

Plainly, the book was intended to make people laugh, and consider. But the Hindu extremists, even before reading it, had made up their minds, they wouldn’t like the book, and the Government, led by a writer Prime Minister, banned the book for political reasons. Even sixty years after its publication, Menen’s book remains banned in India. Meanwhile, the book thrived and went into several editions, more so, since the English language itself prospered all over the world, with the new academic discipline, World Literatures in English.

Another book banned in India about the same time is Nine Hours to Rama by the historian Stanley Wolpert, a University of California professor. This book is a fictional account of the last day of Mahatma Gandhi’s life, and focuses on his assassination. It was banned because it speaks of the poor security, and hints at possible incompetence, and even conspiracy.

More recently, ‘Three Hundred Ramayanas’, an essay by A K Ramanujan, of the University of Chicago, was banned by the Delhi University. The Academic Council of the premier University of India was blissfully ignorant of the fact that the National Academy of India had earlier published A Critical Inventory of Ramayana Studies in the World: basic bibliographical information alone runs into a thousand pages. A whole library can be filled with the Ramayana versions, retellings, interpretations, as well as poetry, fiction, and nonfiction, based on the characters or episodes from the epic. Some of them are not merely critical, but also vituperative.

Nehru was elected President of the National Academy of Letters, India – Sahitya Akademi – ‘not because he was the Prime Minister, but because he had carved out a place for himself as an eminent writer in English’. He was President of the Akademi for ten years, till his death in 1964. As President of the Akademi, he had always upheld the writer’s freedom of expression. In the Akademi too, he had to face demands for removing books from the Translation Programme, for one reason or another.

One such, in the very early days of the Akademi, was Voltaire’s Candide, the French classic, selected for translation into the various Indian languages. Veteran K.M. Panikkar had agreed, in 1956, to translate the book into Malayalam. On re-reading the book, he felt that it was ‘extremely unsuitable for translation into Malayalam’ because it was mainly an attack on the Catholic Church, and would be resented by the Catholics in Kerala. The various incidents alluded to in the book relate to Catholic history. The villains are the Grand Inquisitors, Jesuits, Franciscans and other representatives of the Catholic Order. One of Voltaire’s characters is the illegitimate daughter of a Pope. While the book itself was undoubtedly one of the world’s great classics, its translation into Malayalam would invite a great deal of criticism. Panikkar went on: ‘In view of our Government’s attitude towards books involving religious controversies, e.g. Aubrey Menen’s Ramayana, it may even lead to a book of the Akademi being suppressed and confiscated by the Government. I would, therefore, advise … not to undertake this work, in any case not in Malayalam, and also in other languages.’

Radhakrishnan, the Vice-President of the Akademi, was a renowned scholar, writer, and statesman. He disagreed with Panikkar’s view. The original French edition and its English translation were not banned in India, not even in the Catholic countries of Europe and South America. An attack on the forms of the Catholic Church was not necessarily an attack on the Christian religion. If such objections were upheld, the field of selection of classics would be severely limited. At this rate, Shakespeare’s The Merchant of Venice would be treated as an attack on the Jews.

Nehru agreed with Radhakrishnan, and Candide remained on the Akademi’s translation programme. It was published in five Indian languages. But Panikkar had his way and the Akademi did not publish the book in his language, Malayalam.  Panikkar’s panic, however, turned out to be unnecessary, because, as early as 1947, long before the Akademi came into existence, an advocate had translated Candide into Malayalam and published it. Obviously Panikkar did not know of it. In any case, satires on the gap between religious profession and practice are nothing new. Fifty-five years before Voltaire’s Candide,was Swift’s A Tale of a Tub, another mordant satire on Christianity.

So far, we have been considering the writer’s freedom of expression in books, its profession and practice in Independent India, and its first Prime Ministerwearing two hats, one as the Chief Executive of the largest democracy in the world, the other as the Presiding Officer of the Association of Writers, the National Academy of Letters.

The third Prime Minister of India was Indira Gandhi, daughter of Jawaharlal Nehru. She ruled for sixteen years. Unlike her father, she had no reputation as a writer; consequently, she did not have to wear two hats, of the ruler and the rebel. For our discussion, she plays the most important part. She proclaimed the infamous National Emergency, which lasted a little over two years, from 1975 to 77. She was a popular leader, thrice elected. However, in 1975, the Allahabad High Court, considered an appeal against her election, on the grounds of adopting electoral malpractices, and found her guilty. The verdict rendered her continuance as Prime Minister untenable. She could have appealed to the Supreme Court, against the High Court verdict. Instead, she chose to invoke a constitutional provision and imposed National Emergency, claiming domestic disturbances, and consequent threat to national security. She assumed dictatorial powers, amended the Constitution, subverted democratic processes, ruled with an iron hand, jailed and liquidated the opposition, imposed press censorship – in short, martial law under political guise. Large column spaces of newspapers went blank, because the matter had been censored. Nothing could be published without the Government approval. There was apparent calm and discipline, and some relief from the messy parts of democracy. On the other hand, discontent was simmering, and the Prime Minister’s inner circle was blissfully ignorant of it. Flatterers told the Prime Minister what she wanted to hear. After a little over two years, she decided to legitimize her actions, and called for elections, having been assured by her advisers that she would sweep the polls. She released some of the opposition leaders from jails. The elections, however, were a huge surprise. The Indian electorate decimated the Congress, the Prime Minister’s GOP, and reduced it to its lowest number ever in the Parliament. Indira Gandhi was denied even a membership of Parliament, though she had contested from two constituencies. Thereby ended the darkest period in the story of Independent India.

For our purpose, we shall take up two aspects, the state censorship, and the writers’ response. Journalists and editors were gagged, and couldn’t do much, except whine in private, or in jail. There were a few honorable exceptions. The premier institution of writers, the National Academy of Letters, chose to be silent. This hurt one novelist, Nayantara Sahgal, to such an extent that she chose to resign her membership of the Academy. Here are excerpts from her letter:

The word “intellectual” is something of a farce in India, and during the Emergency it was reduced to total farce, as far as the non-performance of one body, … the Sahitya Akademi, was concerned. Aware of the timidity of the Indian intellectual and his anxiety to stay on the right side of power, I wrote to the … Akademi … on the single issue of censorship, suggesting that … (they) condemn it.  … I reproduce the main part of the letter:

‘The question of free expression and the free circulation of ideas is crucial to a free society.  I should have thought nothing could be as important as this to the Akademi, which is concerned with writers and their work …  failure to bring up this issue … convinces me that the Sahitya Akademi of India does not concern itself with free expression.  Indeed, it seems willing to be a servile body, an obedient servant of dictatorship … had Jawaharlal Nehru, its founder, been alive today, he would not have tolerated such a situation.  He would probably have been in jail, for he would not have kept quiet on any matter concerning human freedom. I regret, I cannot serve on any committee that is so lost to self-respect as to remain silent on the censorship that is strangling India today.  Kindly accept my resignation.’

The Emergency, however, rolled on without a murmur from the Akademi.

After the Emergency, and the elections, the Government led by the new Prime Minister Morarji Desai, restored all the freedoms denied by the Indira Gandhi Government, and the Constitution was restored status quo ante. The nation breathed again.

A chastened Indira Gandhi, however, staged a come back in the next elections, and became Prime Minister again. During her final term, something of literary significance occurred, to do with freedom of expression. 

In 1981, Salman Rushdie won the Booker Prize for his s second novel, Midnight’s Children. The book was sought to be banned in India for its derogatory references to the Prime Minister Indira Gandhi as the Widow, and her son Sanjay Gandhi as Labia-lips. When consulted, the then Chairman of the National Book Trust of India, Krishna Kripalani, advised the Prime Minister not to ban the book, for a ban would only boost the book and invite unhealthy curiosity. Left alone, the book would have its natural cycle. He proved prophetic. While Midnight’s Children had its share of limelight, and faded, his next novel, The Satanic Verses, published in 1988,raised a huge controversy all over the world, for its irreverent references to Prophet Mohammad and the Quranic verses.  India, then under the leadership of Prime Minister Rajiv Gandhi, son of the former Prime Minister Indira Gandhi, promptly banned The Satanic Verses, to appease the Indian Muslims.  From Iran, Ayatollah Khomeni issued a fatwa, calling for death to Salman Rushdie.

Shortly thereafter, the Akademi organized an international seminar on “Freedom and the Writer”, where protests, book bans and fatwas dominated the discussions.

The Akademi Fellow and former Vice-President, Srinivasa Iyengar recalled:

‘The atmosphere was understandably tense, for Ayatolla Khomeini’s death sentence on Rushdie was a lethal radiation racing blindly in various directions.  Not a few present felt caught in a tangle of frustrations, for the subject of the Seminar was indeed an embattled one.  Freedom of expression and publication, an unquestionable and fundamental human right, may legitimately occasion dissent or disagreement, but not prosecution or persecution, and certainly not deprivation of life itself.’  

Eventually, the President of the Akademi wrote the following letter to the Prime Minister Rajiv Gandhi:

I have not read the controversial book, The Satanic Verses, and cannot give any opinion on its merits or otherwise…  All I wish to suggest is that you may kindly consider rousing international opinion to condemn the ‘death sentence’ issued against Salman Rushdie…  Violence, I am sure you will agree, is counterproductive, particularly in matters of mind, and will make martyrs of mortals. In this connection, I may draw your kind attention to the case of Boris Pasternak, in which your distinguished grandfather, Jawaharlalji, intervened, more in his capacity as President of Sahitya Akademi than as Prime Minister of India, and his intervention secured the safety of Pasternak…  I have no doubt that you will continue to uphold the tradition, and do your best to rouse international opinion against the threat to the life of a writer.’

There are more books that raised controversies and protests. Some books were banned, and became, consequently, commercial successes; the books that escaped ban had a normal shelf life and faded.

Another Prime Minister, Atal Behari Vajpeyi, who also wore two hats, of the poet and the politician, faced violent protests and demands for book bans. He said: ‘The poet in me tells me not to listen to the politician in me, and the politician in me tells me not to listen to the poet.’ That was in 2003. We recall that nearly half a century earlier, the first President of the Akademi, also the first Prime Minister of India, too had voiced similar concerns: ‘As President of the Akademi I may tell you quite frankly I would not like the Prime Minister to interfere with my work.’ So the tension between the ruler’s urge to regulate and the writer’s itch to rebel continues.

Let us now turn to the freedom of visual expression. I’ll show you three paintings by M. F. Husain, the bare-foot, best-paid, painter of India; one of his paintings sold for1.6 million dollars at a Christie auction (2008). He was an Indian Muslim artist who had painted, among others, images of Hindu gods and goddesses.  Later in life, he became the target of Hindu extremist groups, who took exception to his nudes of the Hindu deities. His galleries were vandalized; some of his paintings, which had been on view for nearly three decades, were suddenly discovered to be indecent and offensive, and were destroyed. Court cases were filed against the painter. Though the High Court ruled in his favor and upheld his right to freedom of expression, he was heartbroken; he left his beloved Mumbai, went into voluntary exile, and died in London, at the age of 97. The ultimate tribute to the great Indian Muslim maestro was paid by a Hindu artist, Veer Munshi: he painted Husain as a Hindu god. Now, let us take a look at three Husain paintings.

D.S. Rao, Ph.D., is an author, literary critic, retired professor, and former Editor of Indian Literature, the academic and literary bimonthly of Sahitya Akademi, the National Academy of Letters, India. Presently, he is based in Minneapolis, but divides his time between USA and India.


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You think English is easy?


(1)  The bandage was wound around the wound.
2)   The farm was used to produce produce.
3)   The dump was so full that it had to refuse more refuse.
4)   We must polish the Polish furniture..
5)   He could lead if he would get the lead out.
6)   The soldier decided to desert his dessert in the desert.
7)   Since there is no time like the present, he thought it was time to present the present.
8)    A bass was painted on the head of the bass drum.
9)    When shot at, the dove dove into the bushes.
10)  I did not object to the object.
11)   The insurance was invalid for the invalid.
12)   There was a row among the oarsmen about how to row.
13)   They were too close to the door to close it.
14)   The buck does funny things when the does are present.
15)   A seamstress and a sewer fell down into a sewer line.
16)   To help with planting, the farmer taught his sow to sow.
17)   The wind was too strong to wind the sail.
18)   Upon seeing the tear in the painting I shed a tear.
19)   I had to subject the subject to a series of tests.
20)   How can I intimate this to my most intimate friend?
Let’s face it – English is a crazy language. There is no egg in eggplant, nor ham in hamburger; neither apple nor pine in pineapple. English muffins weren’t invented in England or French fries in France. Sweetmeats are candies while sweetbreads, which aren’t sweet, are meat. We take English for granted. But if we explore its paradoxes, we find that quicksand can work slowly, boxing rings are square and a guinea pig is neither from Guinea nor is it a pig.

And why is it that writers write but fingers don’t fing, grocers don’t groce and hammers don’t ham? If the plural of tooth is teeth, why isn’t the plural of booth, beeth? One goose, 2 geese. So one moose, 2 meese? One index, 2 indices? Doesn’t it seem crazy that you can make amends but not one amend? If you have a bunch of odds and ends and get rid of all but one of them, what do you call it?
If teachers taught, why didn’t preachers praught? If a vegetarian eats vegetables, what does a humanitarian eat? Sometimes I think all the English speakers should be committed to an asylum for the verbally insane. In what language do people recite at a play and play at a recital? Ship by truck and send cargo by ship? Have noses that run and feet that smell?

How can a slim chance and a fat chance be the same, while a wise man and a wise guy are opposites? You have to marvel at the unique lunacy of a language in which your house can burn up as it burns down, in which you fill in a form by filling it out and in which, an alarm goes off by going on.
English was invented by people, not computers, and it reflects the creativity of the human race, which, of course, is not a race at all. That is why, when the stars are out, they are visible, but when the lights are out, they are invisible.

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Battle Ultimate

D. S. Rao

Atul Gawande-1

Being Mortal by Atul Gawande. New York, Henry Holt and Company, Metropolitan Books. 2014. Pages, 283, $ 26. 

‘Grow old along with me! / The best is yet to be, / the last of life, for which the first was made,’ sang Robert Browning in the 19th century, when life expectancy in England was forty-seven. In the 20th century, when it rose to sixty, T.S. Eliot wrote, ‘An aged man is but a paltry thing, / a tattered coat upon a stick.’ Both poets lived to be seventy-seven. In the 21st century, with increasing economic wellbeing and phenomenal advances in science and technology, life expectancy has touched eighty in most countries. But medicine has its limitations. It can prolong life, delay death, but, asks Dr. Atul Gawande, is it always a good thing to do so?

The writer-physician begins his book by recalling his medical school seminar discussion on Tolstoy’s classic, The Death of Ivan Ilyich, about the suffering of Ivan, who is bedridden from a fall and suffers intense pain, for which the doctors cannot find cure or relief.  ‘He lives in mounting anguish and fear of death. But death is not a subject that his doctors, friends, or family can countenance’ (2). That is the most painful part, the paradigm, not the inevitable end. Tolstoy recognized this. ‘As Ivan Ilyich’s health fades and he realizes that his time is limited, his ambition and vanity disappear.  He simply wants comfort and companionship. But almost no one understands – not his family, his friends, or the stream of eminent physicians whom his wife pays to examine him. Tolstoy saw the chasm of perspective between those who have to contend with life’s fragility and those who don’t’ (99).  The farm boy Gerasim understands his master better and does his little bit to help. The American medical students saw ‘the failure of those around Ivan Ilyich to offer comfort or acknowledge what is happening to him was a failure of character and culture. The late nineteenth century Russia of Tolstoy’s story seemed harsh and primitive’ (2).

Later, Dr. Gawande recalls from his days as a junior surgical resident the story of a patient in his sixties, suffering from a cancer, incurable but treatable, with only two options: ‘comfort care or surgery’. The patient chose surgery. ‘The operation posed a threat of both worsening and shortening his life.’ The surgery was a ‘technical success’, but he died within two weeks. ‘If he was pursuing a delusion, so were we… We did little better than Ivan Ilyich’s primitive nineteenth century doctors – worse, actually, given the new forms of physical torture we’d inflicted on our patient. It is enough to make you wonder, who are the primitive ones,’ the nineteenth century Russian doctors or the twentieth century American physicians? (3-6).

The contrast between the two cases, separated by a century of medical advances, reinforces the adage: knowledge comes but wisdom lingers.

Dr. Gawande explores the finitude of life and medicine, the delicate line separating the duty of a doctor to save life and the obligation to ensure its quality. He has ‘the writer’s and scientist’s faith… by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing’ (9). And he does this poignantly, provocatively, and preeminently.

Changing family structures and increasing commercialization of medical care have raised the stress on the natural process of ageing and the inexorable end. There used to be a time when family tended the old and the infirm, and most deaths occurred at home. Atul’s grandfather Sitaram Gawande, a farmer in India, respected and venerated by his family, married thrice, outlived his wives, raised thirteen children, lived up to a hundred and ten years, and died with the loved ones around. But times have changed. Children have begun to move away in pursuit of higher education or career prospects, striking roots in far-off lands, while parents preferred familiar places and their own freedom, to moving with children. Even when children are in the same city or country and not too far, independent living of the old is becoming the new norm, but increasingly difficult, giving rise to old age resorts, nursing homes, hospices and assisted living facilities.  Globalization has compounded the problems, when ageing parents and their children are in different hemispheres. Both the generations cherish their freedoms to the extent of leaving the end-life decisions to medicine, insurance, technology and total strangers.

Dr. Gawande notes that in the United States, twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit.

The author records, ‘It is not death that the very old tell me they fear. It is what happens short of death – losing their hearing, their memory, their best friends, their way of life.’  As Felix says, ‘Old age is a continuous series of losses.’ Philip Roth puts it more bitterly in his novel Everyman: ‘Old age is not a battle. Old age is a massacre.’ Things fall apart – words from W. B. Yeats’ ‘Second Coming’ – words so apt that Dr. Gawande uses them as heading for his second chapter; earlier, Chinua Achebe has adopted them for the title of his celebrated novel! Things fall apart. Death occurs not due to any single disease but a mix of multiple biological failures.

Dr. Gawande cites a colleague: we want autonomy for ourselves, and safety for those we love. That remains the main problem and paradox for the aged. ‘Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self’ (106). Some old age homes do not allow the inmates even to play with pets, or take a walk outside, lest they fall and hurt themselves.

Call it concern or crookedness, clinical care or cleverness, families cling to the last straw or play games for whatever reasons; and doctors earnestly think their diagnosis and treatment will work, or, worse, give false hopes, impoverish people, and enrich hospitals. ‘We know the dance moves. You agree to become a patient, and I, the clinician, agree to try to fix you, whatever the improbability, the misery, the damage, or the cost. With this new way, in which we together try to figure out how to face mortality and preserve the fiber of a meaningful life, with its loyalties and individuality, we are plodding novices.’ Novices indeed in these final calls, if the doctors are sincere; or blood suckers and death dealers, if they are not. Either way, it turns out to be ‘a modern tragedy, replayed millions of times over. When there is no way of knowing exactly how long our skeins will run – and when we imagine ourselves to have much more time than we do – our every impulse is to fight, to die with chemo in our veins or a tube in our throats or fresh sutures in our flesh. The fact that we may be shortening or worsening the time we have left hardly seems to register’ (173).

There are three types of doctors: Paternalist, Informative, and Interpretive. The Paternalist Doctor decides what is best for you. The Informative Doctor provides alternatives and asks you to make up your mind. The Interpretive Doctor goes for shared decision-making and asks: ‘What is most important to you? What are your worries?’ and leads you to the decision that most helps achieve your priorities.

In a telling battle simile, Dr. Gawande observes: ‘Medicine exists to fight death. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war you cannot win … you want a general who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end’ (187).

Patients with terminal illnesses move from hospitals to nursing homes, to boredom, loneliness and helplessness. In the absence of a family they could count on, ‘the elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about’ (109). In the name of safety, some nursing homes do not permit the inmates liberties even small children are allowed.

Dr. Gawande rightly cites, ‘culture is the sum total of shared habits and expectations… culture has tremendous inertia. That’s why it is culture. It works because it lasts. Culture strangles innovation in the crib.’ However, some facilities have come up with new ideas. Bill Thomas helped usher into Chase Memorial Nursing Home, a program he called the Eden Alternative, introducing cats, dogs, birds and children, to care for or play with, ‘an opportunity for the inmates to grab on to something beyond mere existence. And they took it hungrily’ (127). But such bold ventures are rare, and remain so. Even the best of homes for old tend to degenerate. Dr. Gawande aptly notes: ‘Nothing that takes off becomes quite what the creator wants it to be. Like a child, it grows, not always in the expected direction.’

According to health professionals, the basic requirements for physical independence are eight activities of daily living: ability to use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk. To live safely on one’s own, eight more capabilities are required: shopping, cooking, housekeeping, doing laundry, managing medications, phone calls, travel and finances.  Paradoxically, we ‘live longer’ only when we ‘stop trying to live longer.’

This is the first non-fiction work I have found hard to put away, partly because of my own age and partly because of the issues the book deals with, issues most people avoid even a mention, though almost everyone faces them some time in life. Dr. Atul Gawande was a participant in the agonizing final years of his father, himself a surgeon. Mother too being a doctor, the family has had cumulative practice of over a century in medicine (123). The scientist-writer’s clinical approach is tempered with genuine warmth; his extensive research does not make the book unduly academic; and his transparent concern for life and death makes the book a compelling read for all.

Being Mortal is a deeply moving, disturbing and haunting book by a practicing physician.

The Publishers, however, would have done better, if they had added a select bibliography and an index.

Dr D Subba Rao

Dr. D Subba Rao

D. S. Rao, Ph.D., is an author, literary critic, retired professor, and former Editor of Indian Literature, the academic and literary bimonthly of Sahitya Akademi, the National Academy of Letters, India. Presently he is based in Minneapolis, but divides his time between USA and India.

1 Response

  1. Mukunda Ramarao says:

    Great review .. useful both to the writer and those who reat it. Thanks for publishing such nice reviews.

    – Mukundaramarao

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