What Really Happened When Jayalalithaa Was Admitted In Apollo Hospital?

Three months post her demise, the Government of Tamil Nadu has finally released details of her hospitalisation. The report, released on Monday (6 March) combines the reports from Apollo Hospital as well as the All India Institute for Medical Sciences (AIIMS).

The report maintains that when admitted, the late chief minister was suffering from diabetes, asthmatic bronchitis, hypertension and hypothyroidism, but clearly denies any trauma such as her being pushed prior to hospitalisation, that has been claimed by politicians. It also busts the myth that she was administered the wrong medication, stating that the only medication she received was corticosteroids for atopic dermatitis and oral hypoglycemic and anti-hypertensive drugs due to the pre-existing conditions of diabetes mellitus and hypertension.

The team of doctors that treated her included 18 from Apollo Hospital alone, along with seven from the AIIMS, 12 specialists including Dr KM Cherian and Dr Richard Beale, along with doctors from Apollo Hospitals in Hyderabad and Bengaluru, TATA Memorial Hospital and Hinduja Hospital Mumbai, CMC Vellore, and also Johns Hopkins Hospital, Baltimore, USA.

The report chronologically lists the events of her hospitalisation:

On 22 September 2016, the hospital rushed an Ambulance to Jayalalithaa’s Poes Garden residence, where she was found with a low oxygen saturation of 48 per cent. Her pulse rate was high at 88 per minute and her blood pressure was 140/70 mm/mercury.

She was admitted to the Emergency Room (ER) where she was diagnosed with sinus tachycardia (high heart rate) and bilateral basal cracks (cracks at the bottom of her lungs) along with pulmonary oedema (fluid present in the lungs due to the heart not pumping enough). She remained in a critical condition even after initial treatment in the ER.

Her Electrocardiogram (ECG) reports were abnormal, resulting in peri-cardiac arrest treatment, which is given to people either before or after a cardiac arrest when the patient’s condition is not very stable. She had a temporary pacemaker installed in her heart due to bradycardia (low heart rate). Her abnormally low blood pressure (hypotension) required medicine infusion as well. She also suffered from a urinary tract infection and Leukocytosis (extremely high white blood cell count) with a White Blood Cell count of 17,690. The hospital also said that it was careful in keeping her past medical history of obesity, hypertension, hypothyroidism and diabetes mellitus in mind while treating her.

The report mentions what ailments that Jayalalithaa was suffering:

She was suffering from fever for close to a week prior to being hospitalised. Blood culture reports indicate growth of Enterococcus, responsible for urinary tract infections. By the third day, she was recovering and requirements for a non-invasive ventilator had reduced, but by the next day her condition had worsened, and she developed tachypnoea (rapid breathing). On 28 September, her condition rapidly deteriorated and after seeking permission from her family and the government, she was placed in a ventilator. In spite of this, her condition was worsening, and by 30 September, she required oxygen supplementation and sedation.

Dr Richard Beale, an intensivist from the United Kingdom was invited by the hospital to provide an expert opinion. He opined that she had a 40 per cent chance of surviving. By then her condition was fluctuating but several paramenters showed improvement. Efforts were made to prevent her from requiring a ventilator but she had developed an acute blood pressure increase as well as hypoxia (lack of blood reaching tissues). At this juncture, multiple doctors from AIIMS and Beale himself were visiting her several times in a day. After gaining permission from her family and the government, a tracheostomy was performed, with an incision in her windpipe to insert a ventilator.

Her kidneys started failing, resulting in lower urinary output by 9 October although she was awake and interactive the next day.

Due to these complications, Apollo was asked to get expert opinions from external cardiologists.Dr Jayan Parameshwar from Papworth UK and Dr Stewart Russel of Johns Hopkins Hospital were consulted and they opined that she had suffered from a diastolic heart failure, where the lower left chamber of her heart did not have much blood. She also suffered from a rare disorder - capillary leak syndrome.

By the first week of November, her feeding tube was removed and she was being fed orally, but due to insufficiency, she had an intra-venous (IV) transfusion. Physical therapy, including sitting on the edge of the bed was encouraged and by 19 Noember, she was moved out of the Intensive Care Unit (ICU), to a specially designed ‘high-dependency’ bed. A consultant from the Apollo Institute of Blood Pressure Management, Hyderabad was called in to suggest treatment due to her repeated episodes of hypertension.

On 3 December, her health worsened, and began requiring more oxygen. She was placed on a ventilator sue to the onset of pneumonia. The next day she had an episode of vomitting. In the late afternoon, while watching television, she complained of breathlessness, following which she was placed on the ventilator and had CPR as well as defibrillation done.

By 5 December, a team of AIIMS doctors arrived and managed to keep her body temperature down. She was put on Extracorporeal membrane oxygenation (ECMO) but suffered a brainstem dysfunction, or brain death with no pulse rhythm and following an all-doctor consultation, ECMO support was discontinued. This decision was then conveyed to Chief Minister O Panneerselvam, Sasikala and Health Minister Thambidurai, along with the Chief Secretary and Health Secretary.

Post discontinuation of the ECMO, she was declared dead at 11.30pm. The discharge reports stated the cause of death as Ventricular Fibrillation, Infective Endocardytis, Acute Respiratory Distress Syndrome.