The Telegraph
Sunday , December 30 , 2012
Since 1st March, 1999
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The miracle that was and that wasn’t
Optimism did count but cascade was too lethal

New Delhi, Dec. 29: The 23-year-old gang rape victim died from a cascade of events resulting from her injuries and overwhelming infection, extinguishing the feeble hopes for a miracle of medicine that the country had been primed to expect.

Her 12-day battle to survive injuries and then infection, including a possible infection acquired in hospital in Delhi, reveal the limitations of medicine and the body’s capacity to overcome grievous assault, doctors said.

“The miracle was that she survived (nearly) 13 days despite her horrendous injuries,” said Yatin Mehta, a specialist in critical care medicine who was among doctors who accompanied her on an air ambulance from Delhi to Singapore.

Doctors believe that the patient’s young age and what some psychologists interpreted as her “extraordinarily optimistic” attitude contributed to improvements in her health before the rapid deterioration and eventual death.

“Age was a positive factor: an older person may not have survived such an assault even one day,” said a senior doctor at the government-run Safdarjung Hospital where she was treated for several days before being moved to a Singapore hospital.

“She also appeared to have a strong will power; she wanted to live — that’s another factor that would, without doubt, have helped her cling on so long,” the doctor, who requested not to be named, told The Telegraph.

The victim, sexually assaulted by six men and mauled with an iron rod on a bus on December 16, had lost her intestines in the attack and subsequent surgery. She had undergone three surgeries and had developed infection, for which she was being treated with last-resort antibiotics.

Doctors said a class of bacteria named Acinetobacter was among the microbes that could have contributed to the overwhelming infection, which led to a cascade of events, including sepsis and multi-organ failure. Acinetobacter was isolated from the patient’s abdomen and lungs, Mehta said.

Critical care medicine specialists say the Acinetobacter is an opportunistic organism, often known to infect highly debilitated patients in intensive care units.

“Her critical condition and the severity of her injuries would have compromised her immunity and made her a candidate for acquiring such a microbe,” said Rajesh Pande, secretary of the Delhi branch of the Indian Society of Critical Care Medicine.

Mehta said tests had suggested that the microbe was sensitive to two antibiotics —meropenem and colistin — and the rape victim had been administered both these drugs. However, doctors believe, the infection overwhelmed her body’s defences.

While she was at Safdarjung, doctors had initially indicated she had improved and was communicating and said she had been taken off the ventilator. The doctors had also said she was “composed and extraordinarily optimistic” about her future.

But the patient suffered a cardiac arrest at Safdarjung on Wednesday and doctors had to use two shocks and a combination of drugs and ventilation to revive her heartbeat. During the three minutes her heart had stopped, she appeared to have suffered some brain damage.

When she was flown to Singapore, she was unconscious, sedated and on full ventilator support with compromised heart and liver functions, a doctor associated with the transfer said.

The Centre’s decision to support her transfer while she was in such a fragile state of health has triggered a debate on whether it was an exclusively medical decision or one influenced by the government.

“I don’t think the medical team would have independently taken a decision that she needed to be shifted,” said Sri Prakash Misra, senior gastro-enterologist at the Moti Lal Nehru Medical College, Allahabad.

The Indian Medical Association (IMA) today asked the government to explain whether the patient was moved purely for medical purposes or whether other factors influenced the decision.

Many doctors have questioned the transfer, with some directly attacking the government, saying it was a political move.

PTI quoted IMA president K. Vijayakumar as saying that the transfer had raised a doubt in everyone’s mind whether the country’s premier hospitals lacked the infrastructure to treat such patients.

“Indian hospitals have infrastructure on a par with their counterparts in other countries. India is emerging as a major centre of medical tourism and, obviously, the shifting of the girl raises the question whether our hospitals lack the necessary facilities,” he said.

Vijayakumar said Indian doctors were “equally competent” to handle such cases.