Tuesday 24 October 2017

Horrifying details of death too much to bear for absent Praveen

SHE wore black polish on her toenails, her ears were pierced with studs and bore the marks of childhood scars on her knees.

These little details of humanity stood out sharply in a poignant catalogue of how infection had ripped with horrifying swiftness through the body of this previously healthy young woman.

By the end, even her bone marrow showed signs of the trauma and inflammation that were symptoms characteristic, we heard, of very severe sepsis.

It was no wonder that Savita Halappanavar's husband, Praveen, could not bear to be here to listen to the devastation. He had stayed away completely from the hearing, his solicitor Gerard O'Donnell explaining that it would be "very upsetting for him".

So he chose to remain at home, steeling himself for the verdict which is expected to come today.

It was a rare infection, we heard, and one which had sparked off phonecall consultations to a London expert in the field of sepsis.

Dr Sebastian Lucas concurred with pathologist Professor Grace Callagy that death had been due to septic shock and an ascending genital tract infection.

"Welcome back to Galway," Coroner Ciaran MacLoughlin gently greeted Dr Peter Kelehan, a native of the county, who smiled warmly in return. There could be little doubt that he would have wished it was under different circumstances.

The retired expert from the National Maternity Hospital had only witnessed so severe a form of infection in patients about four or five times in the entire span of his 40-year-long career, he told us.

None of those patients had died. "But presumably the foetuses died," prompted Eugene Gleeson, Praveen's barrister in cross-examination. "Oh yes," Dr Kelehan concurred, as though almost surprised to be asked.

He went on to outline in detail the extreme rarity of the infection that had stricken Savita when she was at her most vulnerable, suffering the inevitable miscarriage of her baby.

"When you see this you pick up the phone," he said, of what would be his reaction to viewing the products of conception, so infected, under a microscope in a laboratory.

"This is so important you pick up the phone and make the call," he stressed again.

He did not elaborate further but implied that this would – or should – rapidly set off a chain of urgent medical intervention in an endeavour to save the life of the patient.

Dr Kelehan also revealed how the risk of infection is not common in early pregnancy but is "much more common" in second trimester pregnancy loss.

Afterwards, the coroner told the jury that he would be taking the afternoon to write up his summation for today, when he will charge them with the verdicts they may return and what recommendations they may wish to make.

Eager to have every fact correct on the death certificate when it is issued today, there is also another small point he wants clarified. Savita died on the night the clocks went back for winter.

The official time she died stands at 1.09 am – but the coroner wants to know if this is actually the right time. Even being out by an hour would not be acceptable.

Irish Independent

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