Hippocratic: The Columbus Who Dared to Voyage the “el Fin Del Mundo”

The Spanish phrase “el fin del mundo” means “the world's end.” For thousands of years, the western world believed that the Cape of St. Vincent, in southern Portugal was the world's end. It was the most western tip of the known world. It marked the edge of the world, maps ended there, and the people believed that the sun sank there into the ocean. It was a popular belief that sea monsters and fearsome creatures existed beyond that horizon and no one dared to voyage beyond that point. The Portuguese evocatively put it as “el fin del mundo.”

In India, for most patients and their families’, diagnosis of life-limiting condition is “the world's end.” The description of a clinical condition in most of the medical literature often ends at treatment. The horizon where the care has to continue when treatment is not possible is seldom charted. They become directionless compasses in these situations. The physicians who use these compasses to navigate patients are often left clueless. The patients and their families voyage these unchartered waters fearing and experiencing the worse.

According to the Hippocrates, “physicians should refuse to treat those who are overmastered by their disease, realizing that in such cases medicine is powerless.” The Hippocratic Oath does not ask the physicians to cure all the patients. It asks them to maintain the well-being of the patient and respect human life, autonomy, and dignity. The film Hippocratic a biography made on M.R. Rajagopal draws many parallels with the Hippocratic principles. It exposes the challenges involved in caring for patients with chronic and life-limiting conditions, the needless suffering, resource limitations, and lack of awareness. However, it provides hope and inspiration to us about the opportunities that exist to provide compassionate, ethical, and whole-person care. The 18 experiments inculcated by Dr. Rajagopal, the protagonist in the film Hippocratic, changed the course of palliative care provision in India. These 18 experiments were the inspirations drawn from the life of Mahatma Gandhi and the insights generated from his own life experience.

The 18 experiments are as follows:

• Experiment 1: It is health that is the real wealth, not pieces of gold and silver

• Experiment 2: Strength does not come from physical capacity, it comes from an indomitable will

• Experiment 3: Recall the face of the poorest and weakest man you have seen and ask yourself if this step, you contemplate is going to be of any use to him

• Experiment 4: Man becomes great exactly in the degree, in which he works for the welfare of his fellow men

• Experiment 5: You must not lose faith in humanity. Humanity is an ocean; if a few drops of the ocean are dirty, the ocean does not become dirty

• Experiment 6: Poverty is the worst form of violence

• Experiment 7: Where there is love, there is life

• Experiment 8: You must be the change you wish to see in the world

• Experiment 9: A nation's culture resides in the hearts and in the soul of its people

• Experiment 10: A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history.

• Experiment 11: The best way to find yourself is to lose yourself in the service of others

• Experiment 12: Peace is its own reward

• Experiment 13: Noncooperation with evil is as much a duty as cooperation with good

• Experiment 14: The difference between what we do and what we are capable of doing would suffice to solve most of the world's problems

• Experiment 15: A man is a product of his thoughts. What he thinks, he becomes

• Experiment 16: My life is my message

• Experiment 17: Live as if you were to die tomorrow. Learn as if you were to live forever

• Experiment 18: In a gentle way, you can shake the world.

The film begins with a vignette of Dr. Rajagopal's student days. It showed how his inability to help his ailing friend suffering from intractable pain sowed the first seeds of change. The constant reminiscence of his friend underpinned his indomitable will to free India of pain. A small man with a big heart and a big dream went on to setup the Pain and Palliative Care Society in the Medical College, Calicut, in 1993. His continued journey led to the creation of Pallium India, a WHO collaborating center. Heart-wrenching stories of a family of four deciding to end life due to lack of resources, an old lady seeking death because her pain was not controlled and a gentleman ending his life after his pain was controlled highlighted various facets of poorly understood social medicine in India. The film showed his resolve toward implementing effective palliative care through an understanding of social and economic conditions impacting health and disease. The film also showed his decade-long tryst with the Indian legislature and the bureaucracy that facilitated the amendment of the NDPS act.

The Christopher Columbus in his quest to find the new land dared to voyage beyond the “world's end.” His quest led to the discovery of the New World, specifically the Americas. Dr. Rajagopal's quest to find the New World for those patients at their “world's end” set this voyage in motion. His quest enabled many patients and their families to receive palliative care and facilitated palliative care growth in India. However, the New World is yet to be fully discovered for our patients, and the voyage is in the continuum. We have to draw inspirations from his experiments to foster our journey toward palliative care development in India.