Dr. Zeba Hisam (Published in THE NEWS on Tuesday, October 1, 1996) As a doctor I have seen many patients dying and signed many death certificates, but I hadn’t ever observed the death of any close relative since I grew up. My “Nani” died in June this year. I was very close to her. My earliest memories of her go back to a small house in Malir where she lived with Nana, who died when I was a tot – Khala and Mamoo. I still recollect going to Malir to stay overnight. Nani cooked wonderful food, was energetic, doing much of the housework. She prayed, fasted, and recited the Quran every morning. Mamoo and my mother were married off at an early age. My khala, her youngest child, came late in her life There is a gap of 20 years between my mother and my Khala! I was a child when my khala got married. Nani preferred to live with my khala. The latter needed continuous support and help to care for her six children. My khala completed her education privately after marriage, in addition of doing a full time job. I never thought of becoming a doctor. When I was in school I was interested in drawing and painting. I wanted to become an artist but my Nani wanted to see me as a doctor. I used to tell her “I can’t study that much”. She used to ask “why’? I used to answer that “medicine is difficult” and “I was not intelligent enough,” She used to tell me that human beings like you are studying in medical colleges. They haven’t arrived from sky with “surkhab kay par”. “You are the same human being and only hard work is required”. After that I sensed a challenge and subsequently developed a strong desire to fulfill my Nani’s wish. There is no need to tell how happy she was when I passed my final professional MBBS exam. In due course of time, when she turned 89 years old, Nani developed a hoarseness of her voice and later on developed dysphagia (difficulty in swallowing). Initially the symptoms were so mild that she ignored them. She used to have difficulty in swallowing solids once or twice a month. It progressed very slowly. I had to make a differentiable diagnosis. I was afraid to accept what I was looking at, but it became a frightening reality. Nani had cancer of the esophagus. When her endoscopy was performed, the endoscope couldn’t pass beyond the constricting growth. Her biopsy confirmed carcinoma. Her dysphagia progressed further and she had difficulty in swallowing liquids also. She started losing weight I consulted my professor of medicine and subsequently oncologist and surgeons. But everybody suggested the option of radiotherapy. Surgical dilatation was refused by the surgeon regarding the old age factor and her deteriorating general condition. She couldn’t tolerate the harmful effects of uncontrolled radiotherapy. Other procedures were also put aside considering her age. According to my Nani, the people who are not loved and cared for are left to die in hospitals. She used to beg us not to take her to the hospital. She didn’t want any tube to pass inside her to facilitate feeding. She used to say “beta rizq Allah nay aik umer tak rakkha hai, humari umer ziada ho gai hai or hamaray hissay ka rizq khatam ho chukka hai”. If I were not a doctor she had to be admitted in the hospital, but I managed her intravenous infusions continually. Although as a doctor I was helpless and could not do anything for her but as a granddaughter I could make her feel as comfortable as possible. That last Ramadan she fasted and prayed regularly. She walked and moved about doing household chores and accomplishing all her daily pursuits. Then she started deteriorating. She was is my house and visited Khala regularly until one day when she insisted that she be allowed to move back to Malir. She was on continuous parenteral nutrition. Then she started to vomit – even sips of water were too much for her and finally she went without even few sips. She had a fungating huge mass hidden inside her. She had extreme difficulty in clearing her airways due to un-swallowed saliva and sputum. What we could see and estimate about her agony was far beyond our observation than what she was actually suffering. She was praying to God to let her free from her distress. Every day was bringing an enormous deterioration in her body. She was just skin and bones with pains throughout her being. She was mentally very alert till her last moment, recognizing everybody and remembering everyone, but she was unable to talk due to extreme weakness. I thank God that I was beside her when she took her last breath. She put both her arms around my neck and signs of agony, which I cannot describe, were last seen on her face, which were suddenly replaced by a calm and peaceful look when her heart stopped beating and her pupils became fixed and dilated. Her endurance, will power, high spirits will always guide me. Life is a puzzle but death is even a greater puzzle!