The terminally ill who teased death as first-time stand-up comedians

Four patients romance their last days with laughter and highlight the need for palliative care

She's got her make-up done nicely and is taking stock of the audience with a hawk-like gaze when the spotlight envelopes her small frame. She's nervous, but musters enough courage to make her way to the mike. The monologue she delivers over the next few minutes draws considerable applause and laughter, laced though it is with dark humour. Sample this: "I am a Sikh. In fact so Sikh, that I had to be admitted to Guru Nanak Hospital."

Pooran Issar Singh, 85, is no Atul Khatri or Amit Tandon. This is her first gig as a stand-up comedian. But what makes her performance incredible is that Issar Singh is terminally ill and the subject of her humour is her illness which she is well aware is consuming her.

Issar Singh is not the only such stand-up comedian in the country to have found the power within her to laugh in the face of death.

She is part of a unique initiative, spearheaded by the Indian Association of Palliative Care (IAPC), that is attempting to help patients like her cope with the pain, fear and despair preceding death. The public awareness campaign on palliative, or end-of-life, care was conceived by Medulla Communications, a healthcare communications agency.

The show, staged at the Cuckoo Club in Bandra, Mumbai, has been captured in a video tagged #LaughAtDeath, which is reported to have drawn more than 387,000 views in just a day on YouTube, apart from trending on Twitter within 45 minutes of being posted.

Prior to performing before an audience of loved ones and doctors, the performers – Issar Singh, Janice Powell, Narendra Mhatre and Manudevi Singh – who are part of the IAPC network of terminally-ill patients were trained for a few weeks by professional stand-up comedians such as Kunal Kamra, Kashyap Swaroop, Vinay Sharma, Punit Pania, Shriram R and Anand Reghu.

Getting the show rolling, however, wasn't easy. “Getting all the patients together for a shoot was a challenge,” says Mihir Chitre, creative group head, Medulla Communications. “Most visit hospitals regularly for treatment. One patient, in fact, couldn't get up from the bed.”

Says Pania, a professional comic and producer of Chalta Hai Comedy, “To do comedy on a sensitive subject such as death isn't easy. People usually cringe at the thought of dying.” The biggest challenge was to get the patients to laugh at themselves, he says. “What helped was that they were very comfortable being on stage.” 

Before Pania started training kidney transplant patient Mhatre, he met his doctors to understand how to broach the subject of death. 

The campaign also drew flak from some quarters. “Talking about death in India is taboo and the first reaction we got was: 'Death is not funny'. But we went ahead anyway,” says Praful Akali, founder and MD, Medulla. The move paid off. “The patients turned the whole thing around. We also faced criticism from their families but managed to convince them about the benefits of the campaign.”

While the experiences shared were from the lives of patients themselves, some were linked to common events or noted personalities in order to connect with the audience. A case in point is 64-year-old Mhatre's dig at Donald Trump: “Americans wish their new president would be like me, so he doesn't last long.” 

Other forms of humour are strictly personal, such as this quip by 65-year-old cancer patient Janice Powell: “This is the first time I am doing this type of a show. Who knows, maybe it's the last time.” 

Or this one by Issar Singh: “We were six sisters. I am the fourth one. After my three (elder) sisters died, I became the eldest, which means I was promoted. Now my younger sister is waiting to be promoted.” 

Issar Singh, in fact, got so involved in the act that she jokingly admonished a latecomer with this barb: “If you were late by another five minutes, not only the show would have finished but also I would have finished (sic)." 

Caring for terminally-ill patients – those unlikely to survive beyond six months under the assumption that their disease is irreversible – is also an arduous task for their loved ones and IAPC works to address this issue as well.

“In India, most people don’t even know palliative care exists. We wanted to make people understand the meaning of palliative care and to convey that one should make people feel very happy when they are under palliative care,” says Chitre. “If a family member is terminally ill, you can’t start a conversation about death with them.”

In the present scenario, only 3 per cent of cancer patients get even simple pain relief, says Mary Ann Muckaden, president, IAPC. “A campaign such as this can change all that.”

While it was a difficult project, both for the organisers and the patients, the mood was never morose, though there was the stage fright that first-time performers normally feel, says Amit Akali, chief creative officer, Medulla Communication. “They took on the challenge of performing before an audience and opened their lives to the professional stand-up comics, rehearsing hard for days.”
 

Mhatre, whose daughter told him about the campaign, says he thoroughly enjoyed performing on stage. “The show has changed my thinking about life.”

“#LaughAtDeath talks about how close I am to dying and yet it doesn’t,” adds Issar Singh. “The whole idea of laughing at it really touched my heart and so I decided to tease death.” Issar Singh has had high blood pressure and a heart condition for years. In November 2016, dengue struck and “I almost died. But I must thank god for giving me another lifeline.”

The campaign helped the patients increase their will power and confidence, and gave them the zest to live life to its fullest.

Initially hesitant like the others, Issar Singh now says, “It is for a good cause. Whenever I feel tired, I tell myself I'm educating people about palliative care in some way.” And then she adds, “See, you live life king size; and when you die, you die.”

According to one study, India has three million terminally-ill patients with one million cases being added every year. And, one million die every year, mainly due to lack of palliative care. Many are left to fend for themselves in their most painful hours.

Ravinder Mohan, a doctor with CanSupport, a pioneer in palliative care for cancer patients, says, "Proper palliative care can improve a patient's quality of life even when doctors predict limited survival.”

Cancer patients, for instance, remain cut off from society due to general weakness, chemotherapy-induced hair loss and frequent visits to hospital, says CanSupport coordinator Anjali Singh. Palliative care in her organisation includes sessions on laughter therapy, clown therapy, music therapy and art conducted by volunteers who themselves are cancer survivors.

The #LaughAtDeath campaign is an in-your-face step towards creating awareness about palliative care. The patients who have joined it realise they are helping both themselves and others.

“For as long as I have lived, I have faced every problem laughing,” says Mhatre. “So when these guys (at Medulla) told me to make comedy out of my sickness, I was ready.”