Fate, Fatalism...and Stupidity

Srinivas, a 50-years old doctor, had a mild backache that he thought was due to his workouts. When it didn’t settle, he had an X-ray done, which showed a spot in one of the vertebrae, which then turned out to be multiple spots on an MRI. A PET/CT showed a mass in the lungs, that was proven to be cancer. With no risk factors (he was a non-smoker with no exposure to passive smoking and no family history), he suddenly turned out to have metastatic Stage IV lung cancer and after 3 1/2 years of fighting it out, passed away recently.

I could go on and on. Your life could be sailing along fine when suddenly, a truck comes from the side at night and bangs into your car and a dear one dies. Or the plane that you are traveling in crashes. Or you fall into a pothole during the monsoons…which actually happened to a colleague of mine. Or a cement brick falls on you from a height. Or you happen to be crossing the Elphinstone Station over-bridge and it collapses (though this is a form of structural violence on those using local trains in Mumbai by those in power who do not believe that their safety is important).

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Deepa is a close friend. We were doing our internship at Bhagwati Hospital in Borivali in 1986. She stepped off the footpath to go to the restaurant across the road, when a scooter carrying a large rod at 90 degrees just banged into her and she fell down and hit her head on the curb. She was unconscious for 40 days and suffered from post-traumatic changes and her personality changed overnight. She is today an amazing family physician, loved by her patients, but if the accident hadn’t happened, she may have been a leading light in the field of psychiatry. We will never know!

Seema was my neighbor. I had just entered medical college when one day I was told that she had been admitted to Hinduja Hospital for acute liver failure. The next day she was dead. She was my age; we had grown up together and none of this made sense. Apparently, she had taken a paracetamol tablet for a non-specific fever and within 24 hours landed up with that one in million complication and died.

Covid-19 is also an example of this. It came out of nowhere (though some people now believe it’s man-made), swept the world, affected a large number of people and has killed a seven-digit number (3.9 million or 39 lakhs as of writing this) till date, multiple times more than deaths due to any natural disaster or war.

While who we are (genetics, genes) and where we live (environment) often determine our “fate”, the examples I have quoted illustrate something completely different. There are some things that are so completely out of our control, that all we can assume is that someone with a perverse sense of humor is pulling our strings, leaving us completely helpless and perhaps even leading us to believe that “what is destined is destined”and that therefore everything is pre-determined, which can then lead us to be fatalistic.

Noorjahan was a 56-years old lady who was one day detected to have a breast lump that on biopsy turned out to be a malignant cancer. A PET/CT showed axillary lymph nodal metastases, so she was advised a combination of chemotherapy, surgery and radiotherapy. She refused everything saying, “apne taqdeer main jo likha hai, wahi hoga” (“whatever is my fate, that will happen”).  The cancer kept progressing and she died a painful death when it finally spread to the bones.

“Fatalism” is not the same as “fate”.  Fate is what randomly happens to us, though it can sometimes be traced back to our circumstances. Fatalism assumes that all events are pre-determined and that we humans do not have the power to change them.

Many societies and people have fatalistic attitudes; these may be selective, as with pregnancy or conception or diabetes or cancer or may apply to everything they do. And like with Noorjahan, this often results in premature deaths or significant morbidity in life.

Even with Covid-19, I know people who have been very careful but at some point just give up and say “whatever has to happen will happen”, especially if there is a wedding of a near and dear one or if someone close has died and they can’t stand not being there. The situation and context thus matter and rarely is anything an all or none situation.

And then we have cases like these.

Raghu was the Indian CEO of a multinational bank, who landed up with lung cancer. He came from a deep spiritual and cultural background that believed strongly in traditional medicine…his sister was an Ayurveda physician as well. Despite all the evidence put in front of him that his Stage I cancer could be contained by surgery, he opted for traditional treatment for over a year, which gave the cancer enough time to spread and jump from Stage I to Stage IV. At this time, realizing his folly, he finally agreed to his oncologist’s plan of action, but it was too late. He died the next year, though morphine spared him the pain that Noorjahan had to go through.

That is when you want to hit someone. Srinivas landed up with Stage IV cancer through no fault of his and fought it with whatever we have in our armamentarium currently. Noorjahan could have lived long, but believed that the Universe would take care of her…which it didn’t. Raghu, highly educated and intelligent would have done well (Stage I lung cancer has a 90% 5-years survival after surgery), but opted for an alternate pathway that hasn’t worked in such situations for over 5000 years and then died.

Many situations that we now believe are due to “fate” are perhaps just problems waiting for their cause to be discovered that could then perhaps be prevented or treated better in the future. 300 years ago, people believed that small-pox was due to bad miasma and that it was acceptable for many of their children to die. And then just like that, vaccination changed everything, and today small-pox has been eradicated.

Yes, we can’t fight random shitty events that happen to us, but we could try and get over fatalism, depending upon our cultural milieu and socio-economic and educational backgrounds, but stupidity…how do we handle that?

So, what is your matka here? If shit happens, there is not much we can do, except to try and get over it or fight it in the best possible way we can. But, to say that the disease is the will of your God or the Universe, and then do nothing, is to forfeit without a fight, the chance to cure, manage or control it and live longer. And worst of all, if you decide to follow unproven pathways, traditional or otherwise that have no evidence that they work…then I guess only your God or the Universe will be able to help you…and then perhaps not!