" How long will he live? When will it happen?" These are some of the common and difficult questions that a doctor has to answer in his lifetime regardless of the specialty he may happen to belong. The answer to the question is expected in "days, weeks and at times in hours."

And the answer the doctor gives say " two days" spreads like wildfire amongst the relatives of the dying. Simple this may look but there are many interesting issues surrounding this situation. For today let us pick up this thread.

Why do people want to know the possible time of death?

It may be just plain curiosity or the answer is required so that they can get all preparation done for the final journey --- enough time to run for the wooden planks, hay, bamboo trees, the traditional maibas, pungyeibas etc. On other occasions it may be to cook and feed the children well in time or it may be to speedup the marriage ceremony that's already going on. Whatever may be the reason; this answer is expected equally from a doctor and a maiba. And the answer will spread like a wildfire.

Are the doctors trained to answer these questions honestly?

Frankly, as a medical student, I had never attended any class in any discipline, whatsoever, in which the dilemma of dying, prediction of time of death was explained. Rather what we concentrated (in Forensic Medicine) were those after death: time since death, postmortem changes, cause of death etc. Doctors by the existing present curriculum are not trained in class to predict death or manage the circumstances surrounding death. I am not aware of any formula like this

Survival time = (k) x (no. of missed heart beats/min) / 24
where k is a constant.

How do the doctors pick up this art and science?

Like in many such areas in Medical science in this area too the doctors pick up the art and science from the experienced teachers. I have all my respect for Prof Biren in RIMS, Manipur with whom I had a short association. He was a master in this art. It was worth watching him declare death in his gentle way-give the family the positive diagnosis of the patient's dying and the choice to let him die there in the hospital amidst medical fraternity or at home amidst family member (as per our culture and belief).

It is the 'how' and 'to whom' that matters above everything else. I also learnt a lot from our traditional healers, the maibas. A maiba relies mostly on the umbilical beat (khoidou mihun) which is the pulsation of the abdominal aorta (the biggest artery that goes from the heart to the lower part of the body, which carries the pulsation of the heart too) something like the counterpart of the heart sounds which the doctor hears with his stethoscope.

Even though the maiba is not equipped with any instrument he certainly has an edge over the doctor. His experience and his long stay (which sometimes stretches to days together) with the dying which offers him the opportunity to wait and watch the final journey. This medical practitioner cannot or lets say do not afford. These skills and the management skills of his age (we don't see young maibas. do we? )offer him an edge over the young intern who had just passed out of the Modern Medicine.

What the Medical experts say?

Some are of the opinion that doctors should stress the inexactitude of this exercise, and then give one of the four categories: "hours or days", "days or weeks", "weeks or months" and "months and years." If anything, one should tend to err on the pessimistic (i.e. shorter) prognosis. That way if one is wrong, at least the family have had time to make their arrangement as best as they can.

Ah! This brings out the real issue. The soon-to-be bereaved family wants to say a decent farewell to the dying member. When to intervene and when not to intervene is still another area of debate. We will pick up this thread some other day.

Do the doctors really need this skill?

Our profession does not end in providing a good life but extends to the provision of a good death. It is our genuine interest in a patient's life-his body and soul that drives this profession. Can we do without this? Well let me tell you this story. With a cigar in his lips and hands in his pocket a prison doctor declared a dead prisoner, " He is already dead. What can I do?"

A riot followed this and a whole block was burnt down and the jailers had to open fire and control the situation. Three more prisoners died.