Updated: May 18, 2015 2:38:33 pm
Death, in large hospitals, is a daily inevitability involving little more than coping clinically with another days work. And the King Edward Memorial Hospital in Parel, Central Mumbai, is no exception. But if that makes the angry outrage among the hospitals medical and nursing staff over a petition in the Supreme Court, seeking euthanasia for Aruna Shanbaug, appear misplaced, think again.
Long before Pinki Virani, journalist and author of Arunas Story, filed the petition in the apex court, the army of nurses and student nurses at KEM Hospital, perhaps Mumbais busiest, have been thinking about what Aruna wants.
Not whether she wants to live or would prefer to die, but whether Aruna, 62, would prefer Maggi chicken soup or a smearing of mashed banana and sugar on her lips,to be licked in a clumsy, involuntary motion, instead of the mundane blenderised broth of dal and vegetables thats food for the hospitals 1,800 other patients. Even if doctors say she cant tell one taste from another and even if her food is now being fed through a Ryles tube passing through her nasal passage down to her stomach.
Ask why, and the now rehearsed lines are at hand: Aruna is special because she is one of us, the hospitals longest staying inmate, the victim of a brutal crime that has combined all the hospitals few hundred nurses into one solid sorority since November 27,1973. But spend a day with the team of nurses who, among many other things, have charge of the occupant of left side room, Ward No. 4 and what emerges is a story that shatters many myths about Mumbais public healthcare system, unarguably in need of a booster shot but inspiring and fantastical all the same.
It’s 7.00 A.M., and Ward No. 4 is already bustling, sheets being changed on some beds, the floor mopped and fresh batches of medicines being counted by the new shift of nurses.
Staff nurse Neha Kocharekar, 36, on rotation duty in Ward 4, is on the morning shift. Room cleanliness and linen cleanliness are the main morning checks, she says about her duties in the side-room. Shell supervise as the room is swept and mopped,shell ensure that the sheets are clean,that the cupboard is stocked. Sister-in-charge Neelima Naik, 29, ensures there are enough sheets. Aruna wears the hospital clothescotton trousers and a coat, which is a simple shirt. We stock her supplies separately, says Naik, so that we dont run out of anything suddenly.
The morning ritual of sponging is over, with student nurses assisting. An old cassette-player has been switched on. It plays spiritual chants by Wamanrao Pai, the soothing notes appearing to calm Aruna who has been whimpering, as nearly everyday, during the sponge-bath.
Reema Pawar, 50, and Sugandha Rokade, 52, are the senior staff nurses on duty in Ward 4. Through the day, they will be make several visits to the side-room, sometimes only briefly, possibly to check if Aruna is dry, and at other times for up to 20 minutes when she is fed or sponged down and changed. To avoid the discomfort of all-day diapers, we simply check if she has wet herself and change her clothes and linen every time the bed is wet. Diapers are used only in the nightthat too because our night-time staff is thin,with just one nurse and two student nurses, says Kocharekar. There is a four-hourly feed prescribed by the diet department, explains Rokade, milk twice a day, including once with Protinex stirred in.
Every two or three days, a trolley is wheeled in with buckets and Aruna’s short crop is given a wash, the water then swept out of the room through an inbuilt small drain.
By 10 A.M., as the OPDs swell and queues at all counters lengthen, a guard stationed outside the corridor pulls the iron gate half-shutsome visitors today are merely curious about Aruna. Is that the room? Asks a relative of a patient admitted in the upper floors, pointing, before being told firmly that no questions about Aruna will be entertained.
Left side room,one of the four rooms along the corridor leading to Ward No. 4, is identical to the room opposite, the right side-room. It is a large airy room with the high ceilings of the early 1900s when the hospital building was designed and constructed. The walls are tiled up to a height of seven feet. A vintage wooden cupboard stands in a corner across the bed, Arunas supplies of clothes and linen stacked inside neatly. The room, spacious enough to house four patients comfortably, has only one bed, one large window, almost always closed, and a printed, ochre-coloured curtain drawn taut across except when nurses shift it slightly to let in some sunlight. The double-door to the room remains padlocked, and curtained from the outside, its glass panes painted over up to eye level, the higher panes revealing a tubelit room with the ceiling fan circulating the warm afternoon air.
The only people who see Aruna regularly are the nurses and the ayahs. The unit doctor and the dean are the only males who see her regularly, although affidavits in court stated she perhaps cannot even distinguish inanimate objects from people. The nurses say she moves slightly,her wrists and knees bent awkwardly due to contractures, but mostly stays supine, fetal. Her bed has railings on either side, to prevent an accidental fall.
She cries when she is wet. When were passing by or in our changing room just behind,we sometimes hear her and know immediately that she needs to be changed, says Kocharekar.
Matron Archana Jadhav, 57, was a first year student of nursing in 1973,when Aruna, then a senior staff, was brutalised. She was six years senior to me, so I didn’t know her all that well, she says. Like almost every other senior nurse at KEM, she had her turn to nurse Aruna a few years later, when she was posted as in-charge of Ward 4. In those days, she used to take food orally, says Jadhav, a stocky, maternal woman wearing sports shoes since shes on her feet all day. Jadhav has a lot to deal with grueling workload in a hospital that sees more emergency cases and admissions everyday than any other,a crippling shortage of nurses and, now, endless questions about Aruna and people wanting to get a glimpse of her.
At noon, the lunch trolley is making its rounds, its shelf bearing about a dozen large, gleaming steel canisters freshly filled with broth from the Food Department on the ground floor.
Aruna has just been fed, a 15-minute task or less. Earlier, we would smash food with our fingers and feed her bread and milk, or fried fish and curry arranged especially for her we could see she had more happiness eating non-vegetarian food, says Jadhav. She remembers the then dean, Dr Pradnya Pai, visiting Aruna regularly, bringing her flowers from her bungalow, cassettes with old Hindi movie songs, especially by Lata Mangeshkar, and talking to Aruna in Konkani. The Wamanrao Pai cassette was a gift from her too.
A couple of years ago, all of her teeth were extractednot all were in good shape and there was a worry that a loose tooth would be ingested. But even then, she continued to swallow mashed food. It was after a bout of malaria in August-September 2010 that doctors advised a Ryles tube for feeding.
Theres a special indenture for Aruna, made whenever supplies run out: talcum powder, diapers, Protinex or Kabipro powder, soup sachets to break the monotony of hospital food. Lets stock up on eau-de-cologne too, says matron Jadhav.
At 2 PM, retired matron Vaishali Gawde has just completed giving a room full of nurses a brief talk. It is the day after the SC judgment and Womens Day too. Remember that the founder of modern nursing was Florence Nightingale, she reminds the young nurses. Service is the motto of the Lady With The Lamp. And that service, which all of you are providing to Aruna Shanbaug, has put KEM Hospital on the global map today.
Gawde was a senior nurse in the late 1970s, when Aruna was briefly moved to Sarvodaya Hospital, Ghatkopar. We participated in a three-day strike and demanded that she be brought back, remembers Gawde, now a grandmother and living in Kudal in the Konkan. She thinks Viran is petition was nothing more than an unethical move aimed at pushing book sales. But she hits a raw nerve when she talks about the challenges they work under. You, each one of you, has kept Aruna alive, you have shown what nursing is about, doing your duty despite the challenges.
Founded in 1926, the King Edward Memorial Hospital is the financial capitals busiest civic hospital, treating as many as 18,00,000 out-patients and 85,000 in-patients every year. Not only is it one of the nerve-centres of medical care during annual seasonal outbreaks and during times of disaster, KEM is also where patients from across Maharashtra arrive for advanced medical care and complex surgeries. With about 390 staff physicians and 550 resident doctors, the 1,800-bed hospital is one of Mumbais biggest. Needless to say, nurses are overworked, and sometimes brusque. And yet, says senior staff nurse Reema Pawar, you wont catch any nurse complaining about having to look after Aruna maybe any other patient, but not Aruna.
Around 4 P.M.,as evening falls and the crowd of OPD patients, relatives and visitors slowly leave the campus, senior staff nurse Sunita Munj, 42, and nurse Neelam Donde, 38, check on Aruna yet again. They are on the evening shift,and student nurses Minakshi Binawade, 19, and Sevanti Beej, 20, will return soon after lectures.
Ward No. 4, its allotted capacity of 70-odd beds and often bursting at its seams with up to 90 or 100 patients at a time, now has 33 occupantshalf the ward is undergoing renovation and tarpaulin sheets hang like a curtain blocking off the one half. Munj has spent only a few months in Ward 4 recently, but has been posted at least twice here in the past. Munj says shes keen to pass on to her student nurses the same discipline that senior nurses display in caring for Aruna.
Nobody talks about the incident, no gossiping at all. We just do our duty, says Munj. Binawade, only in her second year, says nobody told her in advance about the side-room patient, she just figured it out over a period of time.
That is the most striking feature of Aruna’s caregiversthey go about their routines undramatically, seeking no special honour for looking after her. In fact, theres no ritual introduction for student nurses to the hospitals longest-staying resident. Until the recent media spotlight, many student nurses did not even know the details of Aruna’s case history.
A nurse in an upstairs ward recounts how her husband, who owns Mamta Juice Center opposite KEM, supplied a daily glass of fruit juice for Aruna, free of charge, for over two years. A wardboy remembers that cooked fish would be brought in into the otherwise vegetarian hospital. Some nurses remember massaging oil into her scalp. Others confirm Aruna was menstruating until she was nearly 48. Nurse Donde says Aruna had a bout of diarrhea a couple of months ago. Yet, not one of them is overwhelmed at the kind of service that a patient has received from them.
Quite simply, Aruna gives these simple nurses, working in a chaotic environment, faith. Indeed, many of KEMs redoubtable nurses loathe the mention of Virani, but just as many admit that her petition and the consequent spotlight on Aruna’s case led them to rededicate themselves consciously to the concept of service, not just for Aruna, but as a central theme of their jobs.
Death is easy to ask for, especially in a hospital, says matron Jadhav. But a stark contrast has played out for 37 years in KEM Hospital, through the silent efforts of her team and others before her. Thats why Aruna is special, says Jadhav. She gives us hope.
On the evening of November 27, 1973, nurse Aruna Ramchandra Shanbaug was attacked by a sweeper in KEM hospital where she worked. Allegedly enraged at her for telling him off and threatening to report a theft by him, he accosted her when she was changing in a basement room, wrapping a dog chain around her neck. He tried to rape her but finding that she was menstruating, he sodomised her, the chain twisted around her neck cutting off oxygen to her brain. Aruna was found lying on the floor with blood all over, unconscious.
While her immediate family, including brother Balkrishna Shanbaug and a sister, came to visit her in hospital in the early months after the incident, she was later abandoned by the family. Her fiance, a doctor, reportedly left the country after a few years. A sister, Shanta Nayak, continues to live in Mumbai, not far from KEM Hospital.
Her assailant, Sohanlal Walmiki, was traced soon after the crime and convicted. He spent eight years in prison and was later reported to be working in a Delhi hospital. Little is known of his whereabouts since.
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