The doctors' team that oversaw former Chief Minister Jayalalithaa’s treatment believed she had ‘miraculously’ recovered before she had a sudden cardiac arrest on Sunday (December 4).
While the threat of a cardiac arrest always existed, no one saw it coming because she seemed well on the mend.
From the time she was admitted to the Apollo Hospitals on September 22, Jayalalithaa had moved from an emergency stage to maintenance, and then, to recovery. It was believed — on reasonable medical evidence — that all she needed going forward was rehabilitative care.
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Routine examination
The alarm bells began to ring at 4:15 p.m. on Sunday, shortly after an intensivist walked into Jayalalithaa’s room for a regular check.
She was watching a recording of a television serial and turned a little breathless as he was in the room.
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During the examination, the monitors started beeping, showing fibrillation (irregular contractions of the heart), suggesting she was undergoing a cardiac arrest.
Cardio-pulmonary resuscitation was immediately administered for 30 minutes and crash carts were wheeled in to shock the heart back to normal.
As this was not having the intended effect, a decision was taken to use an Extracorporeal Cardio Pulmonary Resuscitation (ECPR) device — as a measure of last resort. Also known as the Extracorporeal Membrane Oxygenation Device (ECMO), this required a surgical procedure that involved putting in tubes to draw blood from the heart and pump it back after it is oxygenated in a device outside the body.
By then, the alarm had gone out to the rest of the hospital and a team of doctors and nurses hastened to her bedside. “We were only focused on implementing our protocol, we did not think of outcomes, or prognosis then," said R. Senthil Kumar, consultant, Critical Care Medicine, Apollo Hospitals.
Coordinated effort
As the experts began trooping in, the various tasks slowly fell into place, and each of them took up a specific duty – taking turns at resuscitation, trying to ensure it was continuous and sustained; at the same time, an eye was kept on the vitals and arrangements were made for the procurement of blood products.
There were multiple things to do in that room in the three hours that followed, which involved a systematic adherence to scientific protocols. There was no time to think of consequences, the effort was to do what was right. “We did everything, everything possible to resuscitate her then,” recalled Ramesh Venkataraman, consultant, Critical Care Medicine.
However, the problem was a lack of response to the treatment. One source claimed that there was a faint neurological response on the morning of Monday December 5, which lent a faint touch of hope. But this vanished soon enough and it was time to take a difficult and deeply painful call.
Inclusive team
Speaking at an unusual memorial event for the Chief Minister in the hospital on Wednesday, Babu K. Abraham, senior consultant, Critical Care Medicine, said: “All intensivists wonder if we did things correctly, wonder if we could have done better. Yesterday, it is what I did too. We had a very inclusive team; all decisions had to be taken by consensus, the rehabilitative care was excellent. I’m convinced now, that whichever part of the world she had gone to, she could not have got better care.”
He also recollected what Richard Beale, critical care specialist from Guys and St. Thomas Hospital, London, had said when the possibility of shifting her to London was broached: “I can do so, but I doubt I can do anything better.” We learn later that Dr. Abraham had the approval of Ms. Jayalalithaa for his habit of calling a spade a spade.
While doctors train themselves to cope with the loss of patients, build protective mechanisms, this is not a patient they are likely to forget.
Among them is an old friend of Jayalalithaa and Apollo Hospitals chairman Prathap C. Reddy, who said at the meeting: “The first few days were crucial [after she was admitted on September 22]. Each member of the team provided valuable inputs, and a miracle happened; she recovered. All of yesterday, this thought was rocking in me: How did we lose her now, when she had survived the toughest period?”
Preetha Reddy, MD, Apollo Hospitals, speaking through a lingering sense of loss, grasps at the abstract to explain it in some way: “As a team, we really fought to change the course of destiny. We thought we could change destiny, but then, that’s not really in our hands.”