News Analysis

Tuesday 30 September 2014

Maeve Sheehan: From pure joy to absolute tragedy in just seven days

Published 18/11/2012 | 05:00

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The death of this beautiful, young woman has stirred up the bitter war of words on abortion.

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ON Tuesday October 30, a woman's death was registered on the website RIP.ie, the internet equivalent of the newspaper deaths column. Her name was Savita Praveen Halappanavar.

She had died two days before the death notice was posted, "suddenly at University Hospital Galway" on Sunday, October 28. She had lived at 123 Ros Caoin, a housing estate in Roscam in Galway city. The notice said that she was to be removed from a funeral home in Mervue in Galway and brought to a funeral home in Ballybay, Co Monaghan, to "await burial in India".

There was no mention of her age – she was only 31 – or that she was pregnant when she died, or of the loved ones she left behind. There was no hint either in that terse notice of the profound and shuddering effect her death would have after it made front-page news last Wednesday morning. The headlines said – "Pregnant woman dies after being denied an abortion in Ireland" – as the story went international and viral.

Savita's death seemed truly shocking, violently stirring up the acrimonious divisions on abortion that polarised society three decades ago, and setting into stark relief the negligence of successive governments that have refused to legislate for it. On the day news of her death broke, people who never knew her were moved to come together and light candles for her.

From the outpouring of anger, it seemed that Savita's name will join those of Irish women whose personal tragedies became landmarks of supposed social progress.

The schoolgirl, Anne Lovett, who died alone giving birth in a field in Co Longford; Joanne Hayes, the Kerry woman put on trial for killing her newborn baby, born out of wedlock; the 14-year-old known as Ms X who, raped and impregnated, was stopped by the State from having an abortion. Ms X's Supreme Court appeal ruled that abortion is permitted when the life, as opposed to the health of the mother, is at risk and includes the risk of suicide. Successive governments have neglected to translate that Supreme Court ruling into our legislation.

Yesterday, at 4pm, thousands marched in Dublin in protest, organised by an alliance of groups and individuals demanding the Government legislate on the X Case ruling.

Savita's last hours are now the subject of two official investigations that will scrutinise the medical decisions that were made as her condition deteriorated. Her grieving husband, and the couple's circle of friends, has trenchantly suggested that her death was inextricably linked to the failure to terminate her pregnancy.

Savita came to Ireland in 2008 with her husband Praveen. They were a middle-class Indian couple. She had studied as a dentist back home in Belgaum, in south-west India. Her husband had trained as a chemical engineer and got a job with Boston Scientific, a large multi-national based outside Galway that makes medical devices. Savita passed her Irish Dental Council exams, which allowed her to practise in Ireland. She worked part-time at practices in Oranmore in Galway and in Westport in Co Mayo.

They lived in a comfortable housing estate. They were involved in their local community but particularly the Indian community. Savita helped organise Diwali, the annual Hindu festival of light. Their friend CVR Prasad, who is a consultant orthopaedic surgeon at Merlin Park Hospital in Galway, said she was an engaging woman who loved children: "She would gather Indian and Irish children together to teach them Indian dances. She had a diamond in one of her front teeth and all the children would ask, 'ooh, where did you get that'? And she'd tell them, 'aha, you will have to go to India to get that'."

When she became pregnant during the summer, friends said she was thrilled. This was the couple's first baby. She had wished for a baby girl. Savita's parents came from India. They left on October 20, leaving some of their things behind at their daughter's home in Roscam. They planned to return in March, for the baby's birth.

The next day, October 21, a Sunday, Savita was admitted to University Hospital Galway, 17 weeks pregnant and complaining of a pain in her back.

The only account so far of what happened to Savita over the next seven days in hospital until her death has come from her husband, Praveen. The hospital has refused to comment until official investigations are finished.

Praveen recalled last week: "The doctor told us the cervix was fully dilated, amniotic fluid was leaking and unfortunately, the baby wouldn't survive." He said the doctor – who was not named – said it should be over in a few hours. However, Savita's ordeal dragged on for three days.

Praveen said that the baby's foetal heart beat was checked several times a day every day for the next three days. "Savita was really in agony. She was very upset, but she accepted that she was losing the baby. When the consultant came on the ward rounds on Monday morning, Savita asked if they could not save the baby could they induce to end the pregnancy. The consultant said: as long as there is a foetal heartbeat we can't do anything ... ," Praveen said.

"Again on Tuesday morning, the ward rounds and the same discussion. The consultant said it was the law, that this is a Catholic country. Savita said: 'I am neither Irish nor Catholic', but they said there was nothing they could do."

The consultant who, it is claimed, said this to Praveen has not been named either. But the telling phrase, "this is a Catholic country" is the one that international media have zoned in on. It suggests that the country's religious ethos was imposed to deny Savita the termination the family believe could have saved her life.

There may be no laws on the statute books on abortion. But there are medical guidelines. In the vacuum of legislation, the Medical Council published guidelines to what obstetricians are allowed to do when presented with a mother who may die unless her pregnancy is terminated.

The guidelines clearly put the mother's life ahead of that of the foetus: "In current obstetrical practice, rare complications can arise where therapeutic intervention (including termination of a pregnancy) is required at a stage when, due to extreme immaturity of the baby, there may be little or no hope of the baby surviving. In these exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother, while making every effort to preserve the life of the baby."

Savita's baby was dying. According to the Medical Council's guidelines, the consultants treating her would have had to ask themselves the question: was her life at risk by allowing the baby's inevitable death to take its natural course inside its mother's womb?

On Tuesday night, her third day in hospital and her foetus's heart still beating, Savita's condition worsened, according to Praveen. "That evening, she developed shakes and shivering and she was vomiting. She went to use the toilet and she collapsed. There were big alarms and a doctor took bloods and started her on antibiotics," he said.

"The next morning, I said she was so sick and asked again that they just end it, but they said they couldn't."

At lunchtime on Wednesday, October 24, the foetal heartbeat stopped. Savita was brought to theatre to have the contents of her womb removed. "When she came out, she was talking okay but she was very sick. That's the last time I spoke to her," said Praveen.

On Wednesday night at 11pm, the hospital phoned him: "They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable. She stayed stable on Friday but by 7pm on Saturday they said her heart, kidneys and liver weren't functioning. She was critically ill. That night, we lost her."

More than 20 of her close friends gathered outside her room at the hospital, keeping vigil over Praveen and Savita, as she lay dying. Among them was CVR Prasad. "Praveen went to the chapel in the hospital and he prayed. He even spoke to the priest. He was praying for her to pull through. We knew she was in ICU, that it was bad, but there was always hope."

She died in the early hours of Sunday morning. A post-mortem operation was conducted on her body. The findings were reported last week in the Irish Times. She died of septicaemia "documented ante mortem", which means before death, and E Coli ESBL – which is an antibiotic-resistant strain of the often naturally occurring bacterium

Maternal deaths in Ireland are rare and governed by strict reporting procedures. When an expectant mother dies in childbirth, one of the first steps a hospital will take is a risk assessment by internal risk managers. This involves establishing what happened and whether there is a risk of it happening again. According to a hospital spokesperson, this risk assessment took place immediately after Savita's death.

Her death must also be reported by the hospital to a national register of maternal deaths. In the case of Galway University Hospital, it's understood the hospital was still in the process of doing this when the story broke last week. Apparently a delay arose in getting the required input from a particular clinician.

On November 1, the same day Praveen brought his wife's body back to India, University College Hospital Galway reported her death to the national incident management team at the Health Service Executive (HSE). Health Minister James Reilly indicated in the Dail last week that his department had been informed about the incident.

The pro-choice lobby also got to hear about it. Last weekend, rumours circulated that a woman denied an abortion had died. Campaigners who have long been berating the Government for failing to legislate for abortion seized on it, emailing each other on how they should proceed.

The Irish Times had been working on the story for several days before it finally hit the front page on Wednesday morning.

Savita's death was raised by Micheal Martin at leaders' questions in the Dail. He didn't mention abortion or termination once, but called for an independent inquiry.

James Reilly warned repeatedly of the dangers of rushing to judgement, as he had no evidence of a Catholic bias in relation to treatment. But the impact of Savita's story was huge. Praveen was traced to his wife's home in Belgaum last week, where he continued to highlight the tragedy of his wife's death. "What is the use in being angry? I've lost her. I am talking about this because it shouldn't happen to anyone else." Savita's mother raged: "She told them that she was not a Catholic and that she could be saved if the baby was aborted. But the doctors would not listen, citing the law of the land."

By Thursday, the Indian government intervened: "I'm under instructions from my government to approach the Irish authorities and to convey our concern, considering this huge human tragedy and to hear what the Irish side has to say," the Indian ambassador to Ireland, Debashish Chakravarti said before meeting Tanaiste Eamon Gilmore on Friday. "We have said the family should be involved and it should be an independent inquiry."

An expert group appointed by the HSE will forensically examine Savita's last hours. They will presumably ask at what point did doctors believe Savita's life was in danger, and what action they took to try to save her.

But the hospital is likely to take issue with the characterisation of Savita's death, according to a statement issued last week: "We must reserve our position on what action we may take if assertions about patient care are published."

Sunday Independent

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