To recap from our first episode (Where’s Romali...? – Part I), it was Saturday the 1st of April 2017. Dr. Ananda Jayawikrama, an internationally award winning doctor and one of the leading consultants for Dengue in Sri Lanka had advised Romali's parents to take her home until her platelet count goes down to 100 000. Seeing their daughters weakening state and the paing and suffering she was in, her parents thought that Romali's situation was critical and they should not take her home. As a result she was admitted to Asiri Central Private Hospital.
From that Saturday her life was in the hands of Dr. Panduka Karunanayake and Asiri Central Hospital.
After we released the first episode of this tragedy on Lanka News Web, a question raised by most readers was "Why she wasn’t she taken to a Government hospital? Why a private hospital?" We too raised the same question from Romali's parents at the time of our interview.
"Our daughter has never been to a hospital for treatments, and we as parents wanted to take her to the best doctor we could find to get her cured soon; By that time, we didn't know about IDH, it was later on we learn’t that even Dr. Ananda Wijewikrama was at that hospital, which was through our family doctor" The mother answered.
It's really sad and unfortunate that they never knew about the IDH hospital, a hospital with dedicated and talented doctors and a staff carrying out an invaluable service or a job treating 1000’s thousands of dengue patients and curing them, battling not only the disease but also the limited facilities that they are provided to work with. The information they had at the time was that Dr. Ananda Wijewikrama was the best consultant for Dengue treatment and he was treating patients at Asiri Medical Hospital, prompting Romali’s parents to take her there. If Dr. Wijewickrama, being a consultant at IDH for over 7 years and saving more than 11,000 Dengue patients, during his phone conversation, advised Romalis parents to bring her to IDH insted of being told for their daughter to be taken home and brought back to Asiri Medical hospital if her blood count falls to 100 000, we might not be writing this article series today. These are the moments that haunt Romali’s parents and her family everyday for the rest of their lives.
In this context it is also important to understand that Romalis parents just like so many in our country today sought private hospitals for treatments with the understanding and hope that they get the best attention, and the best possibility for quick recovery. Just like any parent they wanted to get their child the best treatment.
Romali’s parents visited IDH a month after later their beloved daughter’s passing with the intention of engaging in a charitable cause to help Dengue patientsce, to learn what they can do to assist in fighting this menance. At which point they see Dr Ananda Wijewikrama.
Her mother recalls, "We went to IDH a few times, and during these visits the doctors told us that they treat the patience patients in their care as if they were their own family members. I saw this with my own eyes. During one of our visits with my son and one of my daughters friends, I saw Dr Ananda Wijewikrama checking a patient with another doctor, they were taking the scan machine from one patient to another. At this point I wanted to go to the doctor and ask, why couldn't you do this to my child? But my son stopped me saying that, Ammi Akki wouldn’t come back even if you do so ".
It was Romalis mother who was at her bed side till her last breath, and it was her father who was like a shadow behind her mother at every juncture. This is why their accounts of each incident holds so much of weight, as it holds clarity and honesty in those words because there is nothing for them to be gained now, because they just want to be heard, they just want justice so that this will never happen to another family again.
"Was there a Dengue Protocol?"
Asiri Central provided Romalis parents a 2 room suite during her treatments. Even her family and friends who came to see her were not allowed near her bed, as she was two weak to even speak and was continously sleeping. The visitors were in a separate room. During the first 4 days most of her day was spent sleeping .
It was very difficult for her to even walk to the wash room. By the third day she was given a wheel chair and was told by the nurses not to let her walk even to the washroom, even to go those few steps to use thein the wheelchair. Even amidst all this the question we are raising is whether Romali received the treatments required by a Denguie patient?
A comparisson should be drawn between the incidents that transpired and treatment administered by Asiri Central hospital to that of IDH which follows a Dengue treatment protocol that should be administered to patients .
When Romali was admitted to Asiri Central Hospital she was down with a severe fever and compaining of a painful headache. Further when she spoke to her brother studying abroad at this time she told him about an unbearable ache in her abdoman. What is important to note in this regard is that these were constantly informed to the people who were incharge of her treatments. Further her day one report showed a platelet count of 144,000 .
Romali's parents were given a pen, a paper and a measuring tool to record the volume of water that she drinks and the volume of urine that she passes.
150ml of water per an hour!
"Give 150ml of water per an hour, but don't exeed the limit" the parents were adviceadvised.
But she was not in a state to drink water.
"Doctors never told us not to give her water; they always said not more than 150ml. But after 3 to 4 months of Romali passing away, we learnt that water is "poison" to a dengue patient, and now we know that these hospital authorities never knew it" said Mr. Rohindra, Romali's father.
Is it negligence? How many patients should pay with their lives for these people's negligence? In a period of any menace both the government and private hospitals should work on one protocol and treat the patients accordingly, if not they shouldn’t take the lives of patience in to their hands, treating them so lightly, increasing the level of risk. Here we are discussing the failure of the whole system in a broader sense .
Romali's mother added, "The hospital authorities came and monitored our daughter’s records and sometimes told us to give her 100ml of water and sometimes to increase it to 150ml. While this was happening they kept changing the administration of saline between 100ml and 150ml ”.
Sunday passed, the time gap between the numbers of times that she passed urine increased. She completely lost her appetite to eat, and it was painful for her to even touch her abdomen.
Even though the doctors and the nurses were informed of this they never conducted an abdomen scan.
Critical 48 hours
Next morning Dr. Pandula Karunanayake came to Romali's parents and said "She has started her critical period"
Every dengue patient goes through a critical 48 hour period. During this period the dengue hemorrhage state gets to its worst, and Romali was in that state, this was her 3rd day at Asiri Central Hospital.
On the third day around 1.00 pm for the first time, a scan was done. When we read the report it clearly mentioned “early fluid leakage”, a sign of worsening condition for a dengue patient. Even with this finding, a second scan was not done the next day, even though she continuously complained of abdominal pains a scan was not conducted till 4 days passed after that initial scan, till the day she left this world.
Romali's father questioned Dr. Panduka Karunanayake, asking him why he didn’t advice for another scan to be done, even after the findings of the report and continued complains by his daughter. The doctors' answer was that there was no reason to repeat the scans, no need to conduct scans repeatedly on third, fourth, fifth days as her blood count reports were satisfactory, mentions her father.
"He said our daughter can even go to the washroom without the wheelchair now" added the mother.
But under the protocol of a government hospital, every patient should be scanned every day. If the doctor is not satisfied with the report a second scan is administered that same day.
"My daughter was at the hospital for 7 days but they did just 1 scan, the second was done two hours before my daughter’s death," said Mr. Rohindra.
When her parents met Dr. Panduka Karunanayake with the scan reports he said that the abdominal pain is because of a muscle problem, “she has a muscle problem, we can talk about it in another two month after she is cured” was what he said.
"We believe that the doctor didn't see ‘early fluid leakage’ being mentioned on the report if he did, he should have conducted a scan the next day which was the 4th, on the 5th and repeated daily till the reports say otherwise ”.
"If the doctor requested for even two scans a day, three scans a day, or even for her to be transfered to ICU, I would have done it, I had no problem, because it’s me who is paying the bill and all we wanted to see was our daughter getting better. But he never asked us to do so, he never did anything" said the Father.
Romali’s parents have reports with information on the investigation conducted by the hospital upon their daughter's death. It mentions “an internal bleeding has occurred in the lower part of the abdomen after 45 hours”. This means 3 days since she was admitted, the 4th of April. But on the scan report which was done on the 3rd of April, it mentions ‘early fluid leakage’. If so what is the accuracy of the statement mentioning bleeding has strated after 45 hours?
"How could they find out and come to a conclusion about internal bleeding without conducting a scan?" asked Rohindra.
"I think this is the doctor's fault, his negligence. Whatever it is, we have lost our daughter now. All I need now is for this to never repeat again, so no family will have to go through the suffering that we are going through" Rohindra added with the pain of losing his only daughter echoing through his words.
"Anybody can make mistakes, even doctors, he is not a god; but what I'm saying is, if the report clearly mentions about a leakage why wasn’t another scan done? Why didn't he scan our daughter until her last day?"
At that moment in time, they had no doubt about Dr. Panduka Karunanayake’s ability to treat their daughter. “We trusted this doctor, I have seen some doctors only spending 5 minutes with their patience patients when they do their rounds. But this doctor examined our daughter for 10- 15 minutes, sometimes came even twice a day. During the critical period, he was their during thrice a day, we didn’t expect a mistake like this to happen from such a doctor” tells Mr. Rohindra .
"I should say what I have to say"
By the 4th of April Romali's platelet count went down to 20 000. Her parents urged the doctor and the nurses to take her to the ICU. But Dr. Pandula advised that it's not needed as he has taken the necessary steps and since the patience patient’s condition was stable. He further mentioned that all she needs is bed rest .
By next morning (5th April) her platelet count dropped to 8,000. On this day through a family connection, a professor came to visit Romali and to see how she was doing. In front of the nurses he mentioned this to Romali’s parents, “ I going to say what I have to say, this hospital hasn’t followed the proper Dengue protocol. They have given too much water to her ”.
By that night she started bleeding from the nose when she sneezed there were drops of blood on the tissue. “Ammi, this is not good, please call the doctor," said Romali. Her parents panicked, but the nurses said it's just a little thing and it's so normal for a dengue patient to bleed this way. After this they used ice to stop the bleeding.
When doctors visited to check on Romali, she constantly complained about the pain in her abdomen. During the 7 days, she has admitted for treatment about 15 doctors visited her. They neglected her complaints and told Romali and her parents that there’s nothing to be afraid of and the pain was due to gastritis.
"15 doctors visited my child and looked at her” Mr. Rohindra mentions showing us the bill, “they have all charged me for the visits, but none of these doctors out of 15, could identify the critical condition my child was in. They have charged LKR 25,062 under medical advice, to just come see my daughter and none of them could identify her condition ".
By evening that Wednesday Romali showed difficulties in passing urine. One Tamil resident doctor who came to visit her, the only one at this stage was deeply concerned about her state and recommended for Romali to be transferred to the ICU. But still it didn’t happen.
Her arms and legs have started to swell, dark circle was beneath her eyes. Her condition was getting far worse to a point of no return.
"Can go home soon!"
Around 3 am on Wednesday the 06th, her platelet count was 10 000, and at about 11 am it went up-to 13 000. Maybe going by there reports even though her condition was still critical the hospital informed Romali’s parents that she can go home the next day or the day after.
She woke up that morning with a smile. Her mother not knowing what was to come felt a hint of happiness seeing her daughter getting back to her old self. “ I thought my daughter was getting better” says her mother.
"Would you like to eat something today?" the mother asked, she preferred to have a yogurt and had half a cup.
The specialist came and he said that Romali was getting better now and could go home by tomorrow.
As such the drip was removed. But unfortunately these were the final few lines of the Haiku poem that was her short beautiful life.
By noon the same Tamil Tamil doctor visited Romali. When he was examining her, she was still in pain, and she still complained about her abdominal pain. "Romali I think you are still not okay." he said.
Romali's mother panicked, she was confused and deeply concerned. She was thinking how they can take their daughter home tomorrow, so soon and take care of her, as she was only just recovering from a critical stage according to her doctors. So when the nurse came Romali’s mother made a request to her, to ask Dr. Panduka to keep Romali in the hospital for at least another two days without her knowing, till she is fully recovered. The nurse promised that she would do so.
In the afternoon she had the rest of her yogurt.
At about 6 pm, Romali called her mother, she was feeling hungry and she had an appetite.
"Ammi can I have Naan from the Mango Tree? Can I have onions and pickle with it? My mouth feels bitter "
She had 3 little mouths-fulfill. Her mother's eyes were filled with tears of joy; she was finally having some food after a long time. She photographed how her daughter took her meal. But she never thought that this would be her daughter's last meal. That photograph captured the last happy memories of Romali and has become a memento .
Around 10 pm that night Romali sent a SMS to her brother who's studying abroad asking whether he is free to talk. Her brother Roshendra called her that instance right away. Due to her condition, he wasn’t able to talk to her for a few days. When he asked Romali how she was feeling she mentioned that she’ll be able to go home the next day or thefollowingg day but her abdomen pain is still there.
She even spoke to some of her friends who visited her that day.
On that faithful fateful day, the 7th of April by about 1am her platelet count dropped to 12,000.
At about 1.15 am Romali was screaming in pain, "Ammi" she shouted weakly. She was crying saying that she has a severe pain in her neck and the left arm.
"Ammi...I can't ....I can't ammi...... something is happening to me. My chest is getting stuck.. my jaw hurts… ammi., my hand hurts…" she was screaming.
By that time she has gotten a blood patch, towards the inside part of her right arm beneath her elbow. Romali's mother rang the bell and 2 nurses rushed.
"The pain is moving towards my back” say Romali crying. Her mother unable to figure out what to do, takes the small Axe oil bottle which was in her bag and starts applying. Unable to bear the pain Romali, hugs the pillow and crouch.
"Sister, is it a heart attack?" Romali's mother asked the nurses with fear for her daughter.
But the nurses said it isn't a heart attack, because if it is the pain would be in the left hand not the right, and they brought Panadol.
"Sister! Pandaol for a severe pain like this?" she screamed and asked with panick in her voicse.
"No no, just don't panic" nurses answered.
Romali vomited, and she sneezed. Blood drops were visible in her tissue again.
The specialist came and checked Romali, and said that it's a "severe gastritis attack!!".
He prescribed Gaviscon.
Romali’s parents begged for her to be taken to the ICU, the doctors answer was that it is not needed since it’s a gastritis attack.
Romali suddenly said she needs to use the wash room. She was taken to the washroom with the help of her mother and the nurses. Romali’s head was resting on her mother. she was unable to even keep her head straight.
When she came back to her bed, she was pale and her whole body was cold. She fell on the bed screaming “I can’t breath, I can’t breath”. Then she suddenly closed her eyes.
“Please open your eyes, please open your eyes”, screamed her mother with fear and panick. Romali’s father ran to her bed jumping on it, slapping her screaming at his daughter for her to open her eyes.
The doctor that prescribed her Gaviscon had left by then, before he did he advised two nurses to be at her bedside at all times.
Romali’s parents repeatedly rang the bell. No one came. the nurses have left with the doctor.
“Rohindra, run and bring the doctors” yelled Romali’s mother.
Then the resident doctor came running with 2 lady doctors.
"She is losing her pulses...Haematoma... Haematoma...." said the resident doctor with who examined Romali with panick. Haematoma means internal bleeding."Call the doctor soon" he said.
It was later her parents got to know that Romali was in having a "Cardiac Arrest".
She was taken to ICU only then, at that last stage. By then it was too late. They lost their only daughter forever.
The loss of this young life shows and highlights to us the failures within our private medical service sector; the failure of the whole system. Our intention is not to punish a single figure, we know that Dr. Pandula Karunanayaka is a veteran doctor who has saved so many lives. The issue or the problem is within the system which we still didn’t speak of ;
See you soon with the final episode.
Contributors: Radika Gunaratne, Hansini Sampath
Translated by : Chavini Abhayasingha
Pix by : Pathum Senarathna