Jayalalithaa's discharge summary released by TN govt: Crucial questions regarding her death still unanswered
A close look at Jayalalithaa's discharge summary and AIIMS medical reports paints a confusing mosaic. Firstpost breaks down the medical jargon and poses the crucial questions that need answering
This is one subject that no doctor dares speak about openly. But privately, doubts are expressed. What really was wrong with J Jayalalithaa? A close look at the discharge summary and the AIIMS medical reports which were released by the Tamil Nadu government on Monday paints a confusing mosaic. Firstpost breaks down the medical jargon and poses the crucial questions that need answering.
The discharge summary prepared by Chennai's Apollo Hospital first speaks of Jayalalithaa's vital signs when she was rushed to Greams Road in an ambulance from her Poes Garden residence. According to the summary, when the paramedics reached Jaya, she was unconscious and breathless, with a slightly higher pulse rate (88/min) and slightly higher blood pressure (140/70) than normal.
Once she reached the emergency room, she was still unconscious and struggling to breathe, and the BP was slightly on the uptick (140/100). The hospital, as a routine, conducted all the requisite tests to check her heart, lungs, kidney functions etc. All tests were normal. Meanwhile, Jaya went into septic shock.
Jayalalithaa, who had been a severe diabetic for 20 years, had blood sugar of 560 mg/dl upon admission. She also had hypothyroidism, and a history of hypertension. As per family members (read VK Sasikala), Jaya was suffering from fever for a week due to urinary tract infection (UTI), a common affliction among women. Apart from all of these, she also had a skin condition known as atopic dermatitis, more commonly known as eczema, which results in itchy skin and rashes. For this condition, her dermatologist, KS Sivakumar, Sasikala's relative, had prescribed oral steroids.
There is a revealing line in the discharge summary: "Her prior medications (including beta blockers and other anti-hypertensives) were modified." Meaning that she was taken off the regular medication and switched to drugs that were more effective.
Now for the questions:
- Why was her diabetes uncontrolled? Was she not taking her medication regularly? Was she prescribed wrong medication, as Firstpost had earlier reported? Diabetes is easy to monitor and control. Especially for a chief minister, who had no dearth of access to good medical care, diabetes should have been the least of her worries. Some doctors opine that her blood sugar could have shot up due to UTI. It is up to those caring for Jayalalithaa at home to answer this question.
- There is no mention of medication taken by her to address hypothyroidism anywhere in the summary. Nowhere is it also mentioned as to what action the consultant team of doctors had taken with regards to that. Unaddressed hypothyroidism can lead, in extreme cases, to patients going into coma. It also affects the heart.
- Why was Jayalalithaa prescribed beta blockers? Beta blockers are medicines for hypertensive patients but they tend to increase the sugar level. Another danger with beta blockers is that if a patient suffers a heart attack, the usual symptoms — sweating, chest pain, dizziness — will not manifest. So, it is virtually impossible to predict if the patient is suffering a cardiac arrest. This is why a severely diabetic patient is usually never prescribed beta blockers, and alternate and more effective medication is prescribed to them instead.
- Why did she suffer from UTI resulting in fever for a week? UTI is common among women and can be cured in a couple of days. In fact, once the hospital started her on drugs to counter the UTI, her urine culture was clear of the bacteria and fungi in two days. Why then did Jayalalithaa suffer the infection for so long?
- Why were oral steroids prescribed for Jayalalithaa, a severe diabetic and known hypertensive? Oral steroids increase sugar levels as well as water retention in the body, which puts an additional load on the heart. There are several effective steroid creams for skin afflictions such as the one Jayalalithaa suffered from. Why were oral steroids preferred over these?
- Jayalalithaa was in septic shock on the day she arrived at the hospital. Sepsis is usually caused by an infection. Initially, doctors treating her seemed to have thought the cause of sepsis was UTI. But by Day 3 of her stay, urine cultures were normal and they were still looking for the source of infection. Where did Jayalalithaa contract the infection from if she was kept in a completely sterile environment with no one except family and medical personnel allowed inside?
- It was only on 3 December, 2016, that Jayalalithaa appears to have been diagnosed with pneumonia, a condition that she did not have when she arrived at the hospital. Where did she get it from? Why was she not diagnosed earlier in spite of all tests of the lungs after Day 3 consistently pointing to pneumonia?
- Global healthcare organisations like the WHO and CDC advocate that anyone — and especially women over the age of 50 years — at risk of diabetes, hypertension and asthma, should take the pneumonia vaccine. However, sitting chief minister was not vaccinated despite having access to the best healthcare available in the state.
- Was a keto-acidosis test done on arrival in the hospital? This is a complication arising out of high diabetes and could have been the cause for Jayalalithaa becoming unconscious. Diabetics who move to keto-acidosis are at risk of slipping into coma. No mention is found in the discharge summary or the AIIMS report on this.
- On the morning of 4 December, 2016, Jayalalithaa was "placed back on tracheostomy mask and required 3-5L/min of oxygen to achieve saturations of 98-100%. She had an episode of vomiting after breakfast". By all accounts, through most of her 75-day stay in hospital, Jayalalithaa did not seem to be in a position to interact or speak, let alone have breakfast orally. How she had breakfast, how she was able to sit up or walk a few steps, and interact with government officials remains a mystery. The anecdote about Jayalalithaa eating idli and teasing Apollo nurses with nicknames like 'King Kong' is likely to be viewed with great scepticism now, with the release of the discharge summary.
- The last page of the discharge summary makes a bald statement: "Neurological examination revealed brain stem dysfunction." This could mean she suffered a stroke. Or a block traveled to her brain. There is no mention of any MRI done in the discharge summary. Did the hospital do one? If they did and there was no block, how did her brain stem dysfunction?
- A clarification raised by the report also begs another question: Family members referred to throughout the summary is VK Sasikala, Jayalalithaa's close friend and confidante, currently at the Parappana Agrahara jail serving a four-year sentence for corruption. How was Sasikala, not a blood relative, allowed to take the call (jointly with government officials) to pull Jayalalithaa off life support and allow her to die?
Answers to these questions may never be known. But it is important that we ask them. The secrecy that surrounded Jayalalithaa's illness, the blatantly false and misleading statements issued by the state government through Apollo Hospitals as well as by AIADMK spokespersons — all of these need to be relentlessly questioned. Jayalalithaa, who was hospitalised with slightly high diabetes, slightly high BP, breathlessness and unconscious, died after 75 days in hospital. At the very least, it is mind boggling.
Treatment summary of former Tamil Nadu Chief Minister J Jayalalithaa
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