The blast at the Delhi High Court last week left 13 dead,but as the media glare moves away,the struggle has just started for the 76 injured,for many of whom life has changed forever.
An analysis of medical records by The Indian Express shows that there are patients with permanently lost hearing,those with vision impaired forever,several with perforated lungs and intestines,many with shattered bones,a few with clots in their brains,one patient who has nerve damage and another with a thousand embedded pellets,many of them on one side of his face.
Doctors say lower-limb injuries were very common in this blast,particularly nail injuries,leading to several cases of amputation. In the 2006 Sarojini Nagar blast and the 2009 serial blasts,patients had upper-body injuries,including lots of chemical and routine burns. This time,we are getting more shrapnel and nail injuries in the lower body, said Dr Mridula Pawar,head of the Department of Anaesthesia and Intensive Care at RML Hospital.
At least four blast survivors at Safdarjung Hospital have suffered perforations in their ear drums,two of whom have additional inner ear damage usually irreversible. Says Dr N N Mathur,director and professor,ENT,at the hospital: Blast injuries affect the ear in two ways. Those in direct line of the sound wave of the blast suffer pressure injuries that affect the drum,or the tympanum. These can be repaired to a great extent surgically. Our patients have already improved by 10-20 per cent.
However,those who may not be in the line of this sound wave may get inner ear damage due to the intensity of the sound. The tymphanum is situated between the external and middle ears. Inner ear damage is difficult to treat since this portion is not surgically penetrable. The only treatment is to put them on steroids. Two victims of the blast under me have suffered such permanent damage, Dr Mathur said.
RML Hospital has at least five patients with such ear damage. This blast was in a very small enclosed space. So the sound waves travelled all around, said Dr U C Biswal,head of Surgery at RML Hospital.
Two victims one at RML and the other at Safdarjung Hospital are complaining of tinnitus,or a constant ringing in their ear. This signifies a problem in the semi-circular canals of the inner ear. The only treatment we can give is steroids, a professor of ENT at RML Hospital said. Without the help of cochlear implants or hearing aids,such patients will never have 100 per cent hearing.
Vinay Kumar,27,has undergone an evisceration or the surgical removal of the eyeball in his right eye. Shrapnel had pierced his right eye. We had no option but to remove the contents of the eye,including the retina and eyeball,leaving behind an outer covering, a senior doctor from the ophthalmology department at RML said. Once he stabilises,we can put a prosthetic eyeball for cosmetic reasons,but the vision in his right eye is gone.
Four patients three at RML and one at the AIIMS Trauma Centre have had their lower limbs amputated and are still in ICU. The most critical is Ratan Lal Shroff,who has lost both his legs. Shrapnel has pierced parts of his lung,causing lung contusions (bruises). The injuries in his chest have damaged capillaries. Hence blood and other tissues have accumulated in his lung tissues, said Dr Pawar at RML.
Given the many complications,including his fluctuating blood pressure,it is difficult to say what quality of life he will have if he survives, a senior doctor said.
Madan Mohan Sharma,55,whose right leg has been amputated below the knee,has extensive arterial bleeding in his right arm. According to Dr Biswal of RML,Excessive bleeding can lead to haemorrhagic shock. We got a lot of patients with blood vessels torn apart. This was one of the few patients we managed to save. Most spot deaths in blasts occur since blood vessels are pierced in multiple locations.
On Monday,Harish Kumar became the youngest victim to have a limb amputated. The 41-year-old had suffered multiple fractures on both legs,and his left foot was amputated from the ankle at RML. Said Dr Pawar: The infection was spreading despite our best efforts,and he ran a risk of septic shock.
Torn blood vessels
Rasid Ali,a 23-year-old who had gone to the court for a hearing of his sisters divorce plea,suffered massive bleeding in the right upper arm after his axillary blood vessels were torn. His arm was almost hanging out. We have repaired this arterial bleeding,and the arm should be usable in future, Dr Pawar said.
Mridul Baxi,34,was one of the two patients to suffer severe head injuries,and he remains one of the most critical patients at RML. The blood clot in his head has been removed,but he also suffered abdominal injuries,with his intestines spilling out. In addition,the femur and tibia bones in both legs were shattered. Neurosurgeons say that considering the large clot that was removed,it is too early to say what impact it might leave on Baxi. After a brain clot of this size,life can never be absolutely normal, a doctor said.
We just had a baby five months ago,after six years of marriage,through IVF. I keep rushing to the Gurdwara Bangla Sahib every chance I get. I just want my husband to live, said Baxis wife Rajni.
The other head injury patient,40-year-old Allaudin,is now stable.
Long bone fractures in lower limbs reduced bones to fragments in case of many victims. Doctors are attempting fixation surgeries but are unsure of their success. Deepak,a lawyers clerk,has suffered fractures in his right femur bone and was referred to AIIMS from RML. His thigh bone has been shattered into multiple pieces. The shrapnel pieces have been removed,now we will attempt an internal fixation surgery to join these bones back, said Dr M C Misra,chief of AIIMS Trauma Centre.
B K Thakur,whose left leg is shattered,also shifted to AIIMS from RML. The tibia in the lower leg and his ankle bone have broken, Dr Misra said.
After the fixation surgeries,the doctors will see the response to the treatment. If the leg doesnt heal soon,we counsel patients for amputation. People are terrified of amputation,but with such damage to the leg,patients often walk better and faster with the help of prosthetics, Dr Misra said.
The risk of pulmonary embolism is also high in such fractures. One of the patients,Pathiran,died after treatment at RML,suffering two cardiac arrests.
Mukesh Kumar Arora is the only victim to have suffered nerve damage. His peroneal nerve that controls movement in the tibial bone has been damaged. He has been operated upon,but it is too early to predict the functioning of the leg, a doctor said.
A software professional who is now recuperating at the trauma block in RML,37-year-old Nitin has over 1,000 pellets inside his face,arms and upper body. Pramod Mahindra,who was operated for fractures in his lower limbs,has a large nail embedded in his ankle. Tarun Yadav,31,has a nail that has got bent into a C shape in his thigh.