-Girish Giri
Patiently, Manoj waited outside the delivery room and she never came back
Patiently, Manoj waited outside the delivery room and she never came back
Manoj patiently waited outside the “female only” delivery room. He had just learnt that his wife had finally entered into labor. Unable to hold back the joy of having his first child to himself, he texted out the news to one close friend. But immediately he began receiving congratulatory messages from all over the town.
However, it only took an instant for Manoj’s greatest moment of joy to turn into his darkest nightmare. He would soon find out that his mother-to-be wife, who had been admitted to hospital in sound health for regular delivery, had breathed her last.
The grief that Manoj is living through has become a reflection of the dark reality of our society. It is an irony that despite all the claims that Nepal has made significant progress in ensuring maternal health, a mother who is completely informed and capable in all respects, who is in sound health, and has access to all health facilities is compelled to such an unjustified death.
***
“timilai piratile badhau:nla; let me tie you up with passion
timisanga maya haru saatau:nla…” let us exchange our love
With much loved songs like these to his credit, Manoj, guitarist of Nepal’s popular rock band 1974 AD, must have been a heartthrob to many of his fans. But he ended up marrying somebody who knew very little about his fame.
They first met about five years ago at her office. She worked in JICA, the Japan International Cooperation Agency, which was celebrating its 40thanniversary in Nepal by organizing a range of programs, including musical recordings. Manoj, who was also engaged with Kathmandu Jazz Conservatory, was coordinating the recordings.
“We first met in JICA when I visited the office for some work related to the recording,” Manoj reminisces.
As he walked out the meeting hall, he chanced upon a young woman passing by with a cup of coffee in her hand. Their eyes met. That interaction was, however, limited to a casual exchange of hellos. But no matter how insignificant that chance encounter seemed, it became a base for building a strong relationship between the two. Manoj’s trips to JICA, now more frequent, would stretch a long way until JICA's 40th anniversary celebrations ended.
“I would always find time between my meetings to seek her out for a quick chat,” says Manoj.
The young woman was Prerana Bishet: young, beautiful, and charismatic. And she always preferred to take life by the horns.
Manoj had relied on one of the JICA volunteers to find ways to get closer to Prerana. And it was her, who surprised Prerana one day when she announced loudly before all her colleagues about Manoj’s arrival. “Prerana san, your boyfriend is here.” Prerana blushed amid the laughter of approval that filled the room.
“She later shared with me that she felt really uncomfortable at that particular moment,” shares Manoj. “She would bring that incident up time and again until much later.”
But that moment also helped transcend their friendship into something more intimate.
“We began seeing and getting to know each other. And two years down the line, we decided to get married.”
Despite coming from different backgrounds—a daughter of a Newar businessman and a son of a local Brahmin family—the two received the blessings of their families for the marriage. They tied the knot on June 29, 2012.
“A lot of girls knew me because of my music,” admits Manoj. “But I ended up marrying somebody who loved me for a whole different reason.”
After the wedding, Prerana also entered the world of Manoj’s music. “She was always a good listener. Among my songs, she especially liked sambodhan, parelima, pahilo junima, and hi:nda hi:ndai the most.”
She would attend his concerts, and analyze his movements and gestures on the stage and later question and comment on those.
After marriage, Manoj also gradually brought changes into his lifestyle.
“I quit attending late-night parties,” he says. “While travelling by air, even the slightest shaking of the plane began to make me feel jittery, something that I rarely worried about earlier.”
He particularly mentions the care Prerana showed towards him. According to him, sometimes when he was consumed by difficulties related to his band, Prerana often took the initiative to help him overcome them.
“Before I met her, I never had the urge to settle down. I always felt that I simply didn’t belong to that category of people who want to get married and settle down,” concedes Manoj. “Even after marriage, whatever time we spent together, no matter how little that ended up being, we spent is as friends.”
***
Having a child was never an immediate priority for Prerana and Manoj. Among other things, they wanted to have a place of their own first. But two years into the marriage, they began getting pressure from friends and relatives and they finally caved in.
“We learnt about her pregnancy last Dashain,” says Manoj. “Based on the advice of many of our friends, we decided to consult OB/GYN specialist Dr. Alka Singh.”
Dr. Singh worked in Sumeru Hospital near their home and also at the Patan Hospital where they were planning to have the delivery.
“From the day we found out she was pregnant, we were very regular with the check-ups and ensured that we did everything as per the doctor’s advice. There were no issues at all. Even the doctor would comment how Prerana was beginning to glow as she progressed with her pregnancy.”
Then on April 25, the earthquake struck, which made both a bit nervous. This made Prerana seriously consider undergoing a caesarian section to deliver the baby, but the doctor refused this option outright.
“There were no complications during Prerana’s pregnancy,” says Dr. Singh. “In such cases, we always advise natural delivery. And that is exactly what I did.” She also suggested natural delivery over caesarian as the former takes relatively less time for the mother to recover post-delivery.
On the 7th of June, Prerana told Manoj that she was not feeling the baby’s movement inside her. They rushed to Sumeru Hospital where Dr Singh informed them that the time for delivery was very near and advised them to get Prerana admitted to Patan Hospital. But before they left, she asked them to perform the final ultrasound. The ultrasound report showed new information which was not known in previous examinations. The report revealed that the baby was entangled in its umbilical cord. The doctor’s note declared it as “minor”. She told them that this would not affect the delivery in any way.
Manoj remembers that he felt a chill pass through his body at that particular moment and recalls requesting Dr. Singh for the caesarian option. The doctor refused his request.
Prerana was admitted to Patan Hospital that night. The next day, when the regular doctor was making her rounds, Manoj and Prerana reiterated their request to go for caesarian delivery, but they were once again refused. Around 4 pm that day, Prerana was given medicine to help induce labor. But since she did not respond to the medicine, she was given another dosage at 10 pm. The labor pain finally started around midnight. But they were completely unaware about the dosage that was administered the second time, and about its potential effects.
Prerana's labor pain was increasing as Kathmandu woke up to another morning. She was shifted into the delivery room at around 5 am. While Manoj had just texted one of his friends about the joyful moment, he began receiving scores of messages from his friends and well-wishers. Right then, he saw a newborn being carried out of the room. A machine was used to aid its respiration.
“All I saw was the baby's black hair, and I really couldn’t tell whose baby it was,” remembers Manoj, “but I felt a strange feeling of attachment towards it.”
Manoj peeked into the delivery room, searching for any signs of what was happening there, but could only see his sister and his mother-in-law. But around him, he heard people's murmurs, about the newborn baby who could not breathe because his throat was entangled in the umbilical cord. As Manoj waited, the nurses took the baby to put inside ventilator.
At around 8:30, Manoj received a message he had least expected to hear.
Due to excessive bleeding, the doctors had decided to remove Prerana’s uterus as a life-saving operation. Dr Singh, who was inside the delivery room, informed him that the operation was imperative to save Prerana. By this time, it had already dawned on Manoj that the baby he had seen earlier was his.
One the one hand, he was not in the condition to decide what action he could take. On the other hand, the doctors were pressuring him to sign off the operation on Prerana.
“If I didn’t agree on Prerana's operation, it would only mean putting her life in danger,” Manoj recalls his dilemma then. “But as I wasn’t sure about the chances of my newly born son's survival, agreeing to the operation could mean that I would forever prevent Prerana the chance of having another child. And how would I explain that to her?”
He went over to the operation room; he saw Prerana lying unconscious. She had an oxygen mask over her face.
“At that moment I felt that I want Prerana at all cost,” says Manoj. “And I approved the operation.”
The doctors began operating in the OT; outside there was a mad rush for the supply of blood.
But a little while later, there was unexpected news that Prerana's heart had stopped. Manoj felt his world go dark.
“Just then a doctor informed that they were continuing to work on Prerana,” continues Manoj, “which brought a ray of hope.”
After some time of mixed information, Manoj was finally led into the operation theatre. And at that particular moment, Manoj felt his world collapse. “I could see Prerana’s body there, but she wasn’t there!” Unable to hold back, Manoj let out a loud cry. Little does he remember of that moment. As they pushed the trolley that held her lifeless body, all he could do was to follow it in tears.
By that time, word of Prerana’s death had spread around town. Tension spread in the hospital as family, friends and well-wishers who had gathered there sought answers from the doctors on Prerana's death.
Meanwhile, Prerana’s body lay somewhere in the hospital, with Manoj at her side weeping.
Then somebody came up to him saying, “Manoj, there’s a big argument going upstairs. Can you come and talk to them?”
At first, Manoj couldn’t really understand what was going on. But when he learnt that the discussion was about finding the cause of Prerana's death by conducting an autopsy, he didn’t feel it was the right thing to do. So he went upstairs and ended the discussion by asking everybody to get over it.
“Overcome by emotions, I think this was the biggest mistake I made,” admits Manoj.
“The fact that I didn’t allow for any investigation then prevents me now from getting the answers to so many questions I have.”
With that decision, everybody made their way for the cremation at Pashupati.
“Even though there was no life in her body, she seemed to radiate so much,” remember Manoj. “I began feeling unrestful about lighting fire over such a beautiful body.”
As he watched the fire slowly consume his beloved wife’s body, somewhere else his newborn was struggling for his life. This was the card that life had dealt him, and he was going to have to play it. And that's precisely what Manoj did. After the pyre burnt down, he went to the hospital to wait on his son.
***
These past days have been full of shocks for Manoj. Many stories are now beginning to emerge from family, friends and physicians. Scores of opinions suggesting that Prerana's death was the result of doctor's negligence have emerged successively. But there is very little chance of getting to the real truth.
- Was Prerana overdosed on the medicine to induce labor which led to the postpartum severe bleeding?
- Did the doctors panic and mistakenly cut an important nerve when they realized the baby was entangled in the umbilical cord? Furthermore, did they make things worse by trying to forcibly stitch her up, leading to her death?
- There is information sourced from a family member of a senior doctor who had made the morning rounds that the doctor had advised to put Prerana on a “short induction” and to perform an operation if that did not induce the labor. Is this the truth?
As Manoj struggles to get answers to these, Setopati reached out to Dr. Alka Singh in Sumeru Hospital.
“Prerana's blood pressure suddenly dropped severely as we were trying to stitch up to prevent excessive bleeding. We decided to remove her uterus since she was bleeding dangerously. Prerana did show some signs of progress as we were removing the uterus. But within moments things turned for the worse, which was caused by a condition called amniotic fluid embolism (a serious condition in which a component of baby inside uterus enters mother's blood stream),” Singh shares.
“We did everything we could,” she adds. “The fact that a person who I oversaw from the very beginning of her pregnancy had to end this way makes me very sad.”
Dr. Singh states that over her 13 years of practise, only 2-3 mothers have died during their pregnancy, but this was first of its kind. When questioned about the cause of excessive bleeding, she asked the Setopati team to visit her at Patan Hospital for further details.
When reminded that another doctor during final regular round of checkup had recommended surgery, Dr. Singh claimed she was unaware about it.
***
Dr. Shilu Aryal, Section Chief of Department of Health Services, claims that Nepal has made tremendous progress in the area of safe motherhood. She said the government has taken many initiatives to get pregnant mothers in rural places receive care at the public health posts.
“However, the government hasn’t showed any attention towards the safety of mothers in urban areas who have access to all the facilities. But if there is significant increase in cases like these, then the government can consider bringing programs that focus on this issue.”
Although Dr. Aryal opines that surgery is the recommended option in cases where a baby is entangled in its umbilical cord, she declined to comment on Prerana's case stating she did not know the details of the case. She did acknowledge that it was unfortunate that a pregnant mother who received all the necessary care and had access to a hospital with all the modern facilities should end up this way.
***
After three days in the ventilator and 12 more days in the hospital, the baby boy was finally discharged and allowed to go home. These days Manoj spends his time playing with his son.
“I spend a lot of time feeding him milk,” says Manoj. “I do end up with sleepless nights.”
Whenever he picks up his phone, there is a picture of Prerana that he has not had the strength to delete. The rooms are still filled with her pictures that constantly keep reminding him of her.
“If the hospital doesn’t give me satisfactory answers, I am going to fight for it,” declare Manoj. “I will be content if my efforts can save other mothers from similar fate. Perhaps, Prerana's soul will also rest in peace after this."
He says his determination is motivated by seeing many who suffer from similar situation but refrain from speaking out and those who do talk but whose stories are not carried by the media. For him, there is nothing else that compensates Prerana's loss.
The day before his son was brought home, Manoj accumulated Prerana's scattered clothes and locked them away in a cabinet. He switched off her phone too.
“There isn’t much one can do,” he continues. “People leave; it’s the memories that linger…” As he kept murmuring his thoughts aloud, I drifted elsewhere to one of his songs—
“hi:nda hi:ndai, dobatoma We were walking together
Timi kata haraidiyau Suddenly you disappeared at the crossroads
Ma bhane chai:n almalera Confused,
Timilai tyahin parkhi rahe:n” I stood there waiting for you
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