Kasaragod: For years, P Ramakrishnan's day began and ended with the needs of his family. An autorickshaw driver from Palathinkal in Bedadka panchayat, he took his four visually impaired siblings to hospitals, banks and government offices, bought medicines, managed household errands and looked after his ageing parents.

The 53-year-old died at Kanhangad District Hospital on Wednesday night, leaving behind a family that had depended on him for much of its daily needs.

Ramakrishnan was diagnosed with advanced bladder cancer two months ago. According to relatives and neighbours, treatment options were limited. His condition worsened two days ago, and he was admitted to hospital, where he died late on Wednesday.

His four siblings -- Thampan, Narayanan, Yashoda and Karthiyani -- are visually impaired. Their father, Kottan Maniyani, a farmer, suffered a stroke five years ago and has since been paralysed and unable to speak. Until then, he had been the family's main support. As his health deteriorated, Ramakrishnan took on much of the responsibility. Their mother, Janaki, is also unwell and undergoing diabetes treatment.

Neighbours said that after work, Ramakrishnan spent most of his time attending to family responsibilities. "(His wife) Usha is also busy looking after the family. She doesn't even get time to go for MGNREGS work. The two of them held everything together," said Govindan, a neighbour.

His brother Narayanan is a teacher at the Government School for the Blind in Kasaragod. Narayanan's wife, Geetha, is partially visually impaired. Thampan is also visually impaired. The two brothers have travelled extensively across India for education, work and other activities, often with Ramakrishnan supporting them from home.

Yashoda is married, while Karthiyani, the youngest among the siblings, requires assistance for most activities, according to neighbours.

About a year ago, Ramakrishnan lost a toe on each foot due to complications from diabetes, said Venu Kakkottama, a neighbour. "Even as his own health declined, he continued to shoulder family responsibilities," he said.

The family faced the biggest setback two months ago when Ramakrishnan was diagnosed with bladder cancer. He stayed at a government-run hostel for nearly a month while undergoing treatment. When doctors informed the family that little more could be done, he returned home. His condition worsened on Tuesday.

Ramakrishnan is survived by his wife Usha, daughter Anushree, a degree student in Mangaluru, son Abhijith, a Plus Two student, parents Janaki and Kottan Maniyani, and his four siblings. "The family depended on him. Now they have to find a way forward without him," said Venu.