Prabaker is dead

Prabaker has died. He was in a cart versus automobile accident, but the cart was carrying steel beams and these beams came through the windshield and completely severed his jaw from his face. Though the tragic events have been read over and again, I am no less sad to lose my favorite character in the novel I’m reading than if it had been written for my eyes only.

Shantaram is loosely autobiographical, which makes it all the more sad that such a wonderful, loving, happy individual once roamed the Earth, or at least Bombay, India, and does no longer. Prabaker brought to life for me the joy in the head waggle (tilting the head from side-to-side to express happiness or agreement) that I see in Nepal. He is said to have had a grin that competed with the sun. He was known for his generosity and open heart. But more than telling you about Prabaker’s good self, dear readers, I want to talk about why he died.

It seems to me that he would not have met his demise from this accident had he lived in the United States instead of India. And why? Because doctors in the US would have spent many, many healthcare dollars on replacing the man’s jaw and surrounding organs and then nurses would have spend many more dollars restoring his to some sort of his former self. He would have received blood transfusions, donor organs, and hours of surgery. It would have been a miracle, perhaps even written up in a medical journal. The question is, despite how much I like him and think he makes the world a better place, do I agree with the expenditure of so much money on one human being’s health?

I suppose someone must take risks and push the envelope – how else would penicillin and aseptic technique been discovered? But how far should experimentation go and at what cost? I have read that in Canada people die because, due to cost, they cannot have procedures that are routine in the United States. But Canada has socialized medicine, which covers basic health maintenance, therefore theoretically minimizing the need for costly procedures.

But, dying, you say, that’s tragic! No, I say; it’s expected and necessary. You’re heartless and callous, you say! So be it, I say.

I believe that healthcare dollars are best spent treating the basic health needs of many, rather than the extraordinary health needs of one. Now, before you start casting aspersions that I’d feel differently if I had a family member who was gravely ill, etc., I have had such a family member. He had brain cancer; he died. From diagnosis to death was a matter of months. Do I wish his death could have been delayed? Yes. But do I wish he had his life at the expense of other people who may not have received care due to cost had more been spent on his care? No.

Perhaps this is why I’m terrified of working as a nurse in a hospital; to have one’s opinions challenged daily is exhausting. To have to earn a living in a way that goes against one’s beliefs is demoralizing. How to reconcile this? Well, thus far I’ve avoided the hospital. I’ve worked in people’s homes (although not without its belief-challenging moments), in a prison, in hospice in the developing world. But not in an American hospital. But now I face a professional crisis: what do I want to do when I return from Nepal? Can I possibly work in a hospital without finding it exhausting and demoralizing? What kind of nurse do I want to be when I grow up?