Does death conclude suffering or merely change its form? Usha came into my life without warning. Not through an oncology clinic or a referral letter, but through a fracture. A fall on the way to seeking care.
Cancer had already been living in her body for a long time quietly, invisibly the way it often does in people who live at the margins. It was the broken femur that finally forced the system to notice her.
When our nuns first saw her at AIIMS Trauma Centre, the scene stayed with them. She was thirty-six, yet her body carried decades of deprivation. Her clothes were soaked with vomitus. There was a strong malodour. Flies hovered. People stood back. Not out of open cruelty, but something more insidious , discomfort, fear, the silent withdrawal that happens when suffering becomes unbearable to witness.
Her body had already begun to lose its social acceptability.
Her husband, Shankar, was everywhere at once. A polio survivor, one limb amputated, raised on the streets of Delhi. He earned his living selling small plants. He moved through hospital corridors on one good leg, trying to understand procedures, trying to arrange food, trying to keep his dignity intact. A few kind hospital staff offered milk and food.
Those moments of kindness mattered not because they solved anything, but because they briefly interrupted neglect.
When the nuns realised she was a cancer patient. They did not see a “difficult case” anymore. They saw a woman nearing the end of life. They spoke to Shankar about hospice care, free treatment, free food, a place to rest. After the fracture was fixed, he agreed.
By the time she arrived at the hospice, cachexia had already consumed her. She was reduced to skin and bones. On arrival she was hypoglycaemic and unresponsive. We corrected what we could. Slowly, she returned not to health, but to awareness.
We told Shankar gently that she was terminal, that death could come at any time. He listened and then said he needed to go home. His younger children were with neighbours. They had missed school for weeks.
We often call this choice in medicine. But I know it was not a free choice. It was a decision shaped by poverty, disability, and the absence of a safety net.
Autonomy, when stripped of options, becomes survival.
Usha lived for eight days with us.
Those eight days mattered deeply.
She regained consciousness. She spoke. She spoke to her children on the phone. She reclaimed her role as a mother, even as her body failed her. Watching her, I was reminded why palliative care exists , not to extend life at all costs, but to restore meaning, relationship, and dignity in the time that remains.
We suggested Shankar bring the children on Sunday. On Monday, Usha died.
Her husband was present. Her children were present. The elder daughter could not be reached as her phone switched off, her number changed. Poverty fractures families in quiet ways. We were told that Usha’s father and two brothers would meet us at Green Park crematorium.
Our administrator, one of our nuns, and a volunteer accompanied the family.
What unfolded there was narrated to me later. But as I listened, I felt it in my body , the heaviness, the anger, the helplessness.
The distance from the parking area to the cremation site was long. The caretakers said the body would have to be carried.(How can Shankar carry the body with one leg ..maybe our public infrastructure assumes able bodies and abandons the disabled). Usha’s father and brothers stood six feet away. They would not touch her. ( don’t know the real reasons).
The ambulance driver demanded ₹800. The nun paid. No one came forward to help. Shankar collapsed into tears. His grief was immense, but his body could not carry what his heart wanted to.
So the nun and the volunteer lifted Usha.
I keep returning to that image how care migrates to those who are willing, not necessarily those who are related. How strangers sometimes perform the most intimate acts when systems and families fail.
At the cremation counter, they were told the charge for wood and cremation was ₹2,000. The receipt was made for ₹1,000. Then came another demand money for “his expenses.” The nun felt humiliated and angry. She wanted to protest. But grief leaves no energy for confrontation. The volunteer quietly gave ₹200. The man’s look said it all: this is not enough.
The nun noticed that other pyres were decorated with flowers. Usha’s was bare. When she asked why, the answer came casually: “This is what you get for ₹2,000. The decorated ones cost ₹13,000.”
In that moment, something became painfully clear , dignity itself had become a commodity. Even death had tiers.
Before lighting the pyre, money was placed beside the body, as custom dictates. Someone passed by and slipped it into his pocket. No one stopped him.
The elder son was asked to light the pyre. He did so without understanding the finality of the act. Afterwards, he returned and cried. The nun held him. She told me later that everything she had been holding inside spilled over sorrow, rage, helplessness, shame.
She said she felt deeply disturbed that she could not even arrange flowers for Usha.
I think what she experienced was more than sadness. It was moral distress , the pain of knowing what dignity should look like, but being unable to provide it fully inside a system that normalises injustice and monetises suffering.
And yet, even here, grace appeared quietly. A goodwill person stepped forward, ready to support the children’s education, a hostel, a chance at a life not entirely shaped by this loss.
Usha did not die with flowers. But she did not die unseen.
As I reflect on this story, I am left with questions that do not resolve easily about stigma surrounding cancer, about poverty and disability, about families that withdraw when care becomes inconvenient, about systems that exploit the most vulnerable at their weakest moment.
As a palliative care physician, I know we cannot repair all of this. But I also know this: bearing witness is not passive. Carrying the body matters. Holding the child matters. Speaking about what we see matters.
Warm regards
Dr Chhaya
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