Anayasena: Essays on Death, Medicine, and Ancient Wisdom
I’m sitting across from a family I’ve never met.
Mr. Kumar’s sons. His daughter. His wife. They’re looking at me with a question in their eyes that I’ve seen a thousand times: Doctor, what should we do?
Their father is on a ventilator. Day nine. Post-stroke. Three medications just to keep his blood pressure up. The scans show massive damage. We’ve tried everything.
The clinical answer is clear. The numbers don’t lie.
But how do I tell them? How do I say: “Your father is dying, and continuing treatment is prolonging his suffering, not extending his life”?
How do I help them choose between fighting and releasing when both feel like betrayal?
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Medical college taught me how to read an ECG. How to intubate. How to resuscitate.
It never taught me this.
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The answers came from unexpected places.
A 75-year-old patient who taught me about ripeness. A Sanskrit prayer about cucumbers and vines. Thirteen-day ceremonies that structure grief with precision modern psychology is only now rediscovering. Death rituals from Japan to Tibet to Madagascar that all learned the same truth.
And from standing at Manikarnika Ghat in Varanasi, watching dozens of bodies burn, understanding finally what it means to confront death without fear.
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Anāyāsena (अनायासेन): without struggle, effortlessly.
It’s an ancient prayer whispered in temples across India: Grant me a life of dignity and a death without suffering.
This six-part series is my attempt to understand what that prayer means. Not just philosophically, but practically. In an ICU at 2 AM. In a family meeting where everyone is crying. In the corridor after the monitors go flat.
It’s about bridging two worlds: the ventilator and the prayer, modern medicine and timeless wisdom, the questions that haunt us and the teachings that might answer them.
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This series is for:
Families standing at a bedside, trying to decide.
Physicians carrying the weight of these choices, wondering if they guided families right.
Anyone who has watched someone die and thought: There must be a better way.
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The journey moves from crisis to teaching to practice. From the questions to the wisdom to the application.
Read in order for the complete journey. Or start wherever you feel like.
Either way, you’re invited into something I’ve been carrying for twenty-five years.
The search for what it means to die well. To let go with grace. To live in a way that prepares us for leaving.
The Complete “Anayasena” Series
This article is part of the six-part series that explores what modern medicine can learn from ancient wisdom about dying well, living with dignity, and letting go with grace.
Subscribe to get an email when the other articles are published.
- How Do I Know I’m Right? The weight of end-of-life decisions
- When the Body Knows. The cucumber, the vine, and ripeness
- The Prayer I Whisper. Anayasena Maranam and dignity in dying
- What the World Taught Me. Ancient wisdom across cultures
- The Conversation Nobody Wants to Have. Guidance for families facing end-of-life decisions
- Coming: The Weight Doctors Carry. The practice physicians need for end-of-life care
This series is being published between February and March 2026.
For more essays bridging medicine and meaning, explore the Medicine & Meaning section.
Dr. Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is the Professor & Head of Internal Medicine at Dr. TMA Pai Hospital, Udupi, under the Manipal Academy of Higher Education (MAHE). While he has contributed to nearly 100 scientific publications in the academic world, he writes on MEDiscuss out of a passion to simplify complex medical science for public awareness.
