Saturday, May 30, 2015

Aruna Shanbaug - Sad story of a Nurse

Aruna Ramchandra Shanbaug (1 June 1948 – 18 May 2015), a young, beautiful, high-spirited, strong- willed girl who hailed from a small village called Haldipur in Honnavar taluk of north Coastal Karnataka (in southern state of Karnataka) alternatively spelled Shanbhag, was an Indian nurse who was at the centre of attention in a court case on euthanasia being in a vegetative state as a result of sexual assault who died from pneumonia on 18 May 2015 after being in a persistent vegetative state for nearly 42 years.

Just like those thousands, she reached Bombay (now Mumbai) with dreams in her eyes, she left her home at a tender age of 18. Her goals were set, she knew what she wanted in her life.

Aruna completed a nursing course in Bombay on her own without anybody’s support. She landed herself a job as a junior nurse in the famous King Edward Memorial Hospital. She was a strict disciplinarian, authoritative, highly responsible and efficient, amongst the best nurses of the hospital. She had a promising carrier ahead and was loved and liked by all.

While working as a nurse in King Edward Memorial Hospital, Aruna fell in love with Dr. Sundeep Sardesai. Both of them admitted the love to each other and soon got engaged. They had even fixed a date for their marriage. That’s when everything seemed very perfect for Aruna.

In November 27, 1973, while working as a junior nurse at King Edward Memorial Hospital, Parel, Mumbai, Shanbaug was brutal sexually assaulted by Sohanlal Bhartha Walmiki, a sweeper ( Ward boy ) on contract at the King Edward Memorial Hospital. Walmiki was motivated partly by resentment for being ordered about and castigated by Aruna. He attacked her while she was changing clothes in the hospital basement.

Walmiki choked her with a dog chain and paralyzed her. Hospital staff found her unconscious 11 hours after attack the dog's chain around her neck had cut by the asphyxiation cut off oxygen supply to her brain, resulting in brain stem contusion injury and cervical cord injury apart from leaving her cortically blind. But she did not die in fact she suffered bravely (and is still suffering) but the damage is irreversible both physically and mentally. Sohanlal did not only snatch her dignity but snatched her whole life, she is bed-ridden, completely dependent on the nurses of the hospital in which she once served other patients.

Walmiki was caught and convicted, and served two concurrent seven-year sentences for assault and robbery but not for rape or sexual molestation (which could have got him a ten-year sentence by itself). Sohanlal got released after 7 years of imprisonment but Aruna still traumatised

Following the attack, nurses in Mumbai went on strike demanding improved conditions for Aruna and better working conditions for themselves. They even succeeded as a police case was registered as a case of robbery and attempted murder. To avoid the social rejection of the victim, and her impending marriage, the original crime of anal rape was concealed by the doctors under the instructions of the Dean of KEM, Dr. Deshpande, perhaps

Aruna is in Permanent Vegetative State (PVS). Her pain is incurable and condition irreversible. She is locked up in her own body to wait for a slow, painful death. Unfortunately, Aruna’s family abandoned her after the hospital started insisting that they should take her home. But the fellow nurses at the KEM hospital in Mumbai had her kept her alive for 42 years. Their love and care for Aruna are highly appreciable.

For Aruna her home became the same hospital where she used to serve whole heartedly. She occupies the same room outside ward 4 of the hospital since 38years.

In 2010, Pinki Virani, Aruna’s friend and activist-journalist filed a petition for euthanasia for Aruna Shanbaug. The Supreme Court praised Ms Virani’s concern, but ruled that her relationship with the patient does not give her right to petition on Ms Shanbaug’s behalf for a mercy killing. The only party that can appeal for euthanasia for Ms. Shanbaug was the staff of KEM Hospital which has nursed her since 38 years. Aruna‘s case is a landmark, while rejecting Virani’s plea for Aruna Shanbaug’s euthanasia, the court laid out guidelines for passive euthanasia. Virani didn’t have anymore to say than a sheer grief over her friend’s pathetic state.

On 24 January 2011, after she had been in this state for 37 years, the Supreme Court of India responded to the plea for euthanasia filed by Aruna's friend, journalist Pinki Virani, by setting up a medical panel to examine her. The court rejected the petition on 7 March 2011. However, in its landmark opinion, it allowed passive euthanasia in India. Pinky Virani has authored a moving book on Aruna Shanbaug titled 'Aruna's Story'.

Rejecting the request for mercy killing, Justice Markandey Katju wrote in his May 2011 judgement "It would be incorrect to say that Smt Aruna Shanbaug is an appropriate case for coma. It appears that for a crucial, critical period her brain was deprived of oxygen supply and this has resulted in her present state similar to that of Cerebral Palsy in the newborn child. It is a condition where brain looses it's coordinatory, sensory as well as motor functions and this includes loss of speech and perception. This has resulted into a state which in a layman's words "Aruna lives in her own world for last 37 years".

She is lying in a bed in a single room for 33 years. She has not been able to stand or walk, nor have we attempted to do that of late because we fear that she is fragile and would break her bones if she falls. Her extremities and fingers have developed contractures and subsequent to non-use; there is wasting of her body muscles. Her eyes are open and she blinks frequently; however, these movements are not pertaining to a specific purpose or as a response to a question. At times she is quiet and at times she shouts or shrieks.

However, I must say that her shouts and shrieks are completely oblivious to anybody's presence in her room. It is not true that she shouts after seeing a man. I do not think Aruna can distinguish between a man and a woman, nor can she even distinguish between ordinate and inordinate object. We play devotional songs rendered by Sadguru Wamanrao Pai continuously in her room and she lies down on her bed listening to them. She expresses her displeasure by grimaces and shouts if the tape recorder is switched off. All these years she was never fed by tube and whenever a nurse used to take food to her lips, she used to swallow it. It is only since September 2010 she developed Malaria and her oral intake dropped.

In order to take care of her calorie make need, nurses cadre resorted to naso-gastric tube feed and now she is used to NG feeding. However, if small morsels are held near her lips, Aruna accepts them gladly. It appears that she relishes fish and occasionally smiles when she is given non-vegetarian food. However, I am honest in admitting that her smiles are not purposeful and it would be improper to interpret them as a signal of gratification. I must put on record that in the world history of medicine there would not be another single case where such a person is cared and nurtured in bed for 33 long years and has not developed a single bed sore. This speaks of volumes of excellence of nursing care that KEM Nursing staff has given to her.

This care is given not as a part of duty but as a part of feeling of oneness. With every new batch of entrants, the student nurses are introduced to her and they are told that she was one of us and she continues to be one of us and then they whole-heartedly take care of Aruna.

In my opinion, this one is finest example of love, professionalism, dedication and commitment to one of our professional colleagues who is ailing and cannot support herself. Not once, in this long sojourn of 33 years, anybody has thought of putting an end to her so called vegetative existence. There have been several Deans and Doctors of KEM Hospital who have cared her in succession. Right from illustrious Dr CK Deshpande in whose tenure the incidence happened in 1973, Dr GB Parulkar, Dr Smt Pragna M Pai, Dr RJ Shirahatti, Dr Smt NA Kshirsagar, Dr ME Yeolekar and now myself Dr Sanjay N Oak, all of us have visited her room time and again and have cared for her and seen her through her ups and downs. The very idea of withholding food or putting her to sleep by active medication (mercy killing) is extremely difficult for anybody working in Seth GSMC & KEM Hospital to accept and I sincerely make a plea to the Learned Counsel and Hon'ble Judges of Supreme Court of India that this should not be allowed. Aruna has probably crossed 60 years of life and would one day meet her natural end. The Doctors, Nurses and staff of KEM, are determined to take care of her till her last breath by natural process.

Pinky believed that keeping Aruna alive in this vegetative state violated her right to live with dignity. But the Supreme Court took note of the care taken by KEM nurses.

Justice Markandey Katju wrote in his judgement "The hospital staff has provided her an excellent nursing care since then which included feeding her by mouth, bathing her and taking care of her toilet needs. The care was of such an exceptional nature that she has not developed a single bed-sore or fracture in spite of her bedridden state since 1973.

According to the history from them, though she is not very much aware of herself and her surrounding, she somehow recognizes the presence of people around her and expresses her like or dislike by making certain types of vocal sounds and by waving her hands in certain manners. She appears to be happy and smiles when she receives her favorite food items like fish and chicken soup. She accepts feed which she likes but may spit out food which she doesn't like. She was able to take oral feeds till 16th September 2010, when she developed a febrile illness, probably malaria. After that, her oral intake reduced and a feeding tube (Ryle's tube) was passed into her stomach via her nose. Since then she receives her major feeds by the Ryle's tube, and is only occasionally able to accept the oral liquids. Malaria has taken a toll in her physical condition but she is gradually recuperating from it."

"Occasionally, when there are many people in the room she makes vocal sounds indicating distress. She calms down when people move out of her room. She also seems to enjoy the devotional songs and music which is played in her room and it has calming effect on her.

In an annual ritual, each and every batch of nursing students is introduced to Ms Aruna Ramachandra Shanbaug, and is told that "She was one of us"; "She was a very nice and efficient staff nurse but due to the mishap she is in this bed-ridden state".

The entire nursing staff member and other staff members have a very compassionate attitude towards Ms Aruna Ramachandra Shanbaug and they all very happily and willingly take care of her. They all are very proud of their achievement of taking such a good care of their bed-ridden colleague and feel very strongly that they want to continue to take care of her in the same manner till she succumbs naturally. They do not feel that Ms Aruna Ramachandra Shanbaug is living a painful and miserable life."

Four decades after, Aruna is finally free. But her demise brings to an end the greatest story of nurses dedication.

While Duttakumar Desai wrote the Marathi play, Katha Arunachi in 1994-95 and was performed at the college level, subsequently it was staged under director Vinay Apte in 2002. Actress Anumol played Aruna in a Malayalam film 'Maram Peyyumbol'.