A young man of 26, Vilas was admitted to the Intensive Care Unit (ICU) of the Bombay Hospital, having fallen from a running train. He had done his doctorate in Chemistry and was going for an interview for a senior chemist's post in a reputed firm. He wanted to go to the United States of America for further studies as his elder brother was a teacher in a School of Pharmacy in Washington DC. However, fate had something else waiting for him. He was denied a visa to the US and had to look for a suitable job in Bombay.

Vilas had suffered a nasty injury to his brain. No one seemed to know how he had sustained the fall. He was neither travelling on the footboard nor had he hung on to the sides. When he was brought to the hospital, he was unconscious. It was noticed that he had sustained an injury to the right side of his forehead. He did move his limb on painful stimuli but the left limb moved less than the right. CT scan showed contusion and oedema of the brain without any space occupying haematoma. He was put on the usual conservative line of treatment that consisted of cerebral dehydration, antibiotics and anti-convulsants.

In the early morning of the next day, he developed severe generalised convulsions that lasted for several minutes. Further dose of anti-epileptic drugs were given and an endo-tracheal tube was passed. For several hours, he became totally unresponsive. Gradually his condition started improving and over the next four days, he became slightly more responsive, trying to move his limbs to painful stimulation.

Vilas's family was in a state of shock. His elder sister Sunanda who was a general practitioner, his elder brother Vidyut who was an orthopaedic surgeon and his younger sister Baby who had just graduated from medical school, had spent almost 48 hours in the hospital with hardly any intake of food or fluid. Vilas's parents who were in their sixties could hardly be consoled. With great difficulty could I manage to send them home to get some rest. Neither of the sisters or brother were willing to leave the hospital and attend to their work.

Vasant, the elder brother of Vilas, telephoned from the States enquiring after Vilas' condition. It was not possible for him to come down to India straightaway unless it was an absolute necessity, as he had an important assignment. He assured me that I should do all that for Vilas and that we should not stint on treatment because of financial problems. He kept on calling me from the States almost daily.He also remained in touch with the family and was a big source of strength to them.

I established a good rapport with the family, spending a fair amount of time with them every day. It was then that I learnt how the family had risen from near poverty to its current status. After graduating from the School of Pharmacy, Vasant had managed to get a loan of Rs 5.000 to pay for his fare to the States for further studies. From this loan, he left money behind with his parents so that the education of his brother sister could continue. When he landed in America he had just enough money with him to last him the next few days. He managed to get into college, took some job on the side and continued his studies. At the same time, he continued to send some money back home to help out his parents.After graduation, he joined the academic staff of the School of Pharmacy and kept on sending most of his earnings to Bombay so that his sister and brother could complete their education. He would not even consider his own marriage in order to be free to help his family. It was with this kind of support that Vilas had managed to get his doctorate in Chemistry in Bombay. This accident, therefore, was extremely traumatic to Vasant who had almost been a father figure to his brother.

The love that bound the family together was unbelievable. After an initial improvement, Vilas' condition became static, semi-vegetative. Though the family had hired a private nurse to look after Vilas round the clock, two of the family who were medicos stayed with him all the time. Even after his condition ceased to be critical. Vilas was never left alone. Either Sunanda, Vidyut or Baby remained with him, neglecting their medical practice, even though they could not afford to do so. They kept nursing him, cajoling him, all in the hope that they could liven him.The old father regularly appeared at the hospital on the dot of four in the afternoon and stayed with his son till seven in the evening.

After a lapse of three weeks, Vasant came down from the States. I found him to be a noble soul, full of humility, profusely thanking me for all the medical help I had rendered to Vilas. Though he tried to keep his cool, it was apparent that he was shattered. He had helped Vilas to get educated and was looking forward to his successful career. Now all his hopes had vanished. Being a pharmacist, he went laboriously through all the medical literature to find if there was any drug that could pull Vilas out of his semi-vegetative state. A repeat CT scan did not show any su cally treatable malady. Vasant stayed on in Bombay for nearly months, never away from Vilas' bedside hoping to see some signs of progress. Sunanda was goaded into getting on with her practice, at least for some hours of the day. Vidyut and Baby continued to relieve Vasant from time to time. The private nurse was kept on so that Vilas could get the best of nursing care. The family must have spent a fortune in doing so.

At the end of two months, Vasant had to get back to the States. One could see the agony written all over his face when the time came for him to leave. We had become good friends by then and I could appreciate the emotional turmoil he was going through. On the day he was leaving, he came home for dinner. Whilst taking leave, he broke down and sobbed on my shoulder. God had really been unkind to a man who had gone through untold hardships and who through dint of hard work had come up in life and brought up the family.

Vilas' condition tended to fluctuate from time to time. He developed intercurrent infections that did respond to antibiotics. However he gradually withered away, not having improved sufficiently even to recognise his parents, brothers and sisters. The private sisters who were nursing him had also got very much attached to him and his family and were putting their heart and soul in looking after him. Finally, at the end of four months, Vilas passed away, leaving behind a desolate family and dejected nursing and medical personnel. I felt as though I had lost a member of the family.

The devotion one saw in the family was unique. Despite their having exhausted their resources, and despite the illness being protracted, they ungrudgingly and lovingly did their best. Seldom have I seen such solidarity in a family, placing the unfortunate brother much above themselves, showering love and nursing him till the end, hoping for the miracle to occur and appreciating all that the medical personnel could do. I have become a member of their family since then.

Compilation of professional reminiscences of specialists - edited by M.V.Kamath and Dr.Rekha Karmarkar