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You Are Herewith Sentenced To Life

Let Aruna die? No, with her alive, there’s more power, media attention. Hence, the politics of mercy in medicine.

You Are Herewith Sentenced To Life
PTI Photo
You Are Herewith Sentenced To Life
outlookindia.com
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Lucknow airport. Late ’90s. Khushwant Singh and I are waiting for our flights, we talk about Prime Minister A.B. Vajpayee mentioning my book Once Was Bombay in a speech on collapsing cities. He suddenly asks, “You wrote that book on the woman who neither lives nor dies, you still see her?”

I say I’m banned by the hospital. Nothing new for me, though. Each time egos change—deans, doctors, matrons—I’ve redone the process with these authorities to stay in touch with Aruna Shanbaug. It’s a pattern since 1982.

This time I should have been grateful for infrequent consent to visit her locked room. Instead, I had questioned their mandate. I had reported to newspaper editor Bachi Karkaria that the doctors had violated Aruna’s right to live with dignity. They had withdrawn permission for her complete medical check-up. Granted, as it were, after my physical and telephonic running around for several agonising days.

The full medical in a private hospital, at no cost to this municipal hospital, would have inspected Aruna from head to toe. Testing would have ranged from blood-routine to vital organs and a brain-scan. A skilled anaesthetist would have made the procedures painless for Aruna. Her rotting teeth, due to infected gums, would have also been dealt with. An ambulance with a private doctor would have picked up Aruna in the night since she had not felt sunlight for more than two-and-a-half decades. I also signed a letter taking all responsibility.

The idea, after the complete examination, was to consult top medical minds. On their recommendation for follow-up treatment, I planned to approach the Bombay High Court and point out that since Aruna’s medical care was at the mercy of a doctor-bureaucracy which had not conducted any further tests on its own, my husband and I—as responsible, tax-paying citizens—were willing to be appointed guardians. We would buy the best medicines, ensure the treatment.

To the left is the pretty picture of Aruna, the one I released of a 16-yr-old. The 62-yr-old reality is a twisted, brittle skeleton.

Aruna is denied the medical tests, permission withdrawn at the last hour. Reason given? None. After much angry persuasion, the response is the same as that given by the nurses when preventing her from receiving physiotherapy: “Supposing something happens to her?”

Aruna Shanbaug. Sodomised. Strangled with a dog-chain while being brutalised. Extensive brain stem injury, partially brain-dead. Cortically blind. Cannot speak. Or walk. No control over body movements. Administered mashed food, swallows automatically, upchucks equally. Teeth loosening and falling—one by one—on her bed. In pain. Shrieking. Howling. Weeping. Laughing manically. After the initial days, no medicines prescribed by the doctors, so none given.

Abandoned by friends; authorities don’t encourage their visits as they are not blood relatives.

Abandoned by relatives; they used to be constantly told by this free hospital to “take her home”. I’ve been told too. I would if I could; but it doesn’t change the fact that Nurse Aruna Shanbaug has every right to remain in that hospital. Hers is a case of aggravated sexual harassment and assault in the workplace. The hospital would have had to pay large cash compensation plus provide permanent care had her relatives been well-educated, not poor, and had access to a responsive legal system.

Abandoned, too, by municipal doctors; and here is the supreme irony. The daily devotion of her nursing colleagues has been so systematically thrust upfront that it has successfully masked the medical mismanagement of Aruna’s case by key municipal doctors. Hypocrites also take the Hippocratic oath. After Aruna was brutally assaulted, no doctor at the hospital was willing to file a complaint that drew attention to the fact that she had been anally raped, even though there are now claimants to “being there first to treat her”. The result: the sodomiser walked free after a mere seven years in jail for robbery.

And so, equally abandoned by the law.

Aruna Shanbaug. Born June 1, 1948. Murdered-but-not-killed November 27, 1973.

Khushwant Singh then asks his second question,

“You think there is a God?”

***

Delhi. 2009. I’m standing below the flag of India that flies above the main dome of the Supreme Court. I look up at it. If God has abandoned Aruna too, can’t we at least ensure that her pain is validated by her country?

My plea as her “next friend” must have been heard by some divine force, listening in just then. For the Supreme Court decides to accord that dignity to Aruna Shanbaug which has been denied to her for more than three-and-a-half decades by admitting the case.

The plea simplified: Please define Right to Live with Dignity as enshrined in Article 21 of the Constitution. And if this is not it, please taper out the force-feed.

Cut to 2011. Because of the Supreme Court’s orders, after 37 years, Aruna Shanbaug gets what she should receive annually: a medical check-up.

If I were consulted, I would have recommended two doctors. From the UK, where vegetative pain management intertwines with compassion. From Liege, where research combines with machines to evaluate levels of patient consciousness.

The medical report confirms that she fulfils most criteria of those in a permanently vegetative state. Such patients do not have favourite foods, music, people. Their smiles are not reactions to external influences. She is incurable.

But Aruna Shanbaug must not, cannot, die. Not when there are medical names involved in this medico-legal case. There are promotions, file-markings, resident quarters, spacious flats in prime residential areas. Everyone can move on to private practice or retirement; none need return to her locked room. Meanwhile, with Aruna alive, there is more power, more media attention, international conferences. And so they play their politics around the motives of mercy in medicine.

The medical report comes with a brief CD on Aruna as she is today. It is shown in the packed court-room.

The might of the state against the individual starts its road-roller grinding.

Look, no bed sores.

Listen, she is not completely brain-dead or she would not be making those noises.

See, she moved. She is not in a full coma.

Cures are being found everyday.

When the state is looking after the suffering, outsiders need not be concerned.

It is against Indian culture.

My poor, poor Aruna. All I have, standing in this one corner, is my choice to be morally accountable for you, no matter the consequences in the Court of God.
And then, his voice cutting through the clutter of righteousness, I hear the judge use the words “passive euthanasia”.

***

This, too, is how landmark judgements come to a country.

Please see the Supreme Court website where it has been uploaded. Please see whether the court thinks Aruna’s current situation is a “life” even though it rules that she must “live”. The status quo of the caregivers as deciders of her fate has been maintained, but do read the bit that tells you they can approach the high court should they ever come to “change their mind”.

Meanwhile, because of this broken woman denied the choice, all of India has one. Passive euthanasia is legalised—it remains in effect at least till Parliament rules otherwise—and none need suffer the way Aruna Shanbaug has. And continues to.

Another gift. The order on euthanasia offers clarity on organ donation in medico-legal cases. Crucial time tends to get lost over definitions of brain death, consequently healthy vital organs are frequently wasted.

That CD shown in the court? It is so gruesome that even the generally no-holds-barred regional television channels are unable to run it in full. Thus, what you have been seeing is the pretty picture, the one I released of a 16-year-old girl who had it framed and put up in her village home before she left it.

The 62-year-old reality has been locked away. Always in pain, no palliatives prescribed. No teeth. White cropped hair. A feed-pipe running from her nose to her stomach. Feral sounds from a twisted and brittle skeleton. From which finger nails continue to grow, cut into her palms. Prone to diarrhoea, yet no catheter. Doomed to a very painful, and very slow, death.

Aruna Shanbaug. Prisoner of the state, held hostage by the quality of its mercy.


(Pinki Virani, a national award-winning author and activist, moved the Supreme Court on behalf of Aruna Shanbaug asking for her force-feeding to be stopped so that she could die peacefully. While not permitting that, the apex court delivered a landmark judgement on passive euthanasia.)

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