K. JAVEED NAYEEM writes: Satyameva Jayate, which literally means “Truth Stands Invincible” or “Let Truth Prevail”, is a mantra from the ancient Mundaka Upanishad believed to have been written by our sages in 250 BC.
The slogan was popularised and brought into use by Pandit Madan Mohan Malaviya in 1918 when he was serving the second of his four terms as president of the Indian National Congress, and it was later adopted as the national motto of India after Independence.
Today it is inscribed at the base of our national emblem, the Ashoka pillar, and is also found on every one of our coins and currency notes, handled by the rich and the poor alike but without anyone ever noticing either its presence or significance whatsoever.
While it was meant to keep our conscience in a state of constant wakefulness to uphold the greatness of our rediscovered nationhood, we Indians with our dishonest ways and dark deeds have sadly kept its guiding light out of our murky lives.
Today, ‘Satyamev Jayate’ also happens to be the title of a very popular TV show being aired on every Sunday morning to tell us Indians all the wrong that is happening in our country which we need to set right.
Very recently, in the fourth episode of this widely watched television show, its host Aamir Khan, the popular film hero, chose to speak about health-care services in India and the threat of ‘rampant’ medical negligence. He called on real life ‘victims’ to share their trauma.
One such victim of alleged medical malpractice was retired Army officer Major Pankaj Rai who lost his wife Seema to what he called a badly botched up kidney transplantation operation.
Without naming anyone or any hospital during the course of the show, he said that his wife died as a result of gross medical negligence at a very reputed hospital in the country when she was subjected to a combined kidney and pancreas transplant that was done without the consent of the patient herself or any of the family members.
What Aamir Khan perhaps did not tell his viewers was the fact that on his show he was all along showing them only half-truths about what had actually happened.
And, mind you, half the truth is very often a great lie.
All details of the Seema Rai case are now available on the internet at the click of the mouse button. You can easily find out that the transplant surgeon who was accused of being inadequately trained and ill qualified to carry out the operation was actually someone who was trained in the United States with good experience in multi-organ transplantation.
The physician and nephrologist who treated the patient and managed her on dialysis for more than two years before she underwent transplant surgery too had 16 years of clinical experience in the US before he chose to return to India to serve fellow Indians.
He has been practising in India since 2003 without any charge having been levelled against his competence either in the US or in India.
Now, whenever a doctor who has been able to survive and practice in the US, which is one of the most paying but also certainly one of the toughest environments to practice medicine, chooses to return to a country like India, we cannot easily garland him with the accusation of either being selfish or inefficient.
This doctor in question, therefore, does not need me to write a page of unqualified and unpaid defence for him, to uphold his reputation or image, especially when I do not even know him personally.
Major Rai alleged on the show that the doctors who did not even have a licence to do the job, whisked his wife off to surgery in the middle of the night without his or her consent and transplanted the kidney of a cadaver donor, along with a pancreas, that was not only an unnecessary medical procedure but also one that risked his wife’s life as well.
What our famous host or his aggrieved guest did not tell us during the show—where they were applauded and cheered by their captive audience—was the fact that this case of alleged medical negligence has been heard by more discerning experts.
The State medical council in its ruling has clearly said there was absolutely no medical negligence involved and there was no motive of personal monetary gain on the part of the doctors. The incident has also been debated over by many professional bodies both in India, and abroad too, including a law University and all of them have ruled that there was no element of medical negligence involved in it whatsoever.
Despite these rulings, the family has chosen to pursue the matter with a claim for a steep monetary compensation and the matter is sub-judice still.
No monetary compensation can do any, let alone full justice, for a human life lost and for the ensuing pain but while the matter is still undecided they should not have aired their angst with misrepresented facts on a TV show meant for the masses hungry for sensational scoops.
It appears the patient who was on dialysis had registered for cadaver kidney transplantation with a government body called the zonal coordination committee for transplantation (ZCCT). Now, cadaver transplantation means the transplantation of organs harvested from brain-dead persons, which is resorted to when living relatives with matching tissues are not available to donate their organs.
In such a situation whenever a suitable organ becomes available, as it usually happens after a fatal road accident, the patients on the waiting list are informed and asked to report immediately if they are interested in getting the transplant done. There is very little time for this procedure to be undertaken as the organs from a brain-dead donor have a very limited lifespan before they are transplanted.
In the case of a kidney, it is best transplanted within six hours after death and usually not more than twenty-four hours to ensure best function after transplantation.
Moreover, the decision-making has to be fast here as other waiting prospective recipients have to be informed if the first one refuses. And, even after a prospective recipient is identified some more hours are needed to establish tissue compatibility.
Therefore, the summons from the hospital for a cadaver transplant patient to quickly get admitted sometimes comes only as an urgent midnight call and there is nothing surprising about it.
On May 1, 2010, when the ZCCT, the agency that allocates cadaver kidney organs, informed that a potential cadaver had been identified and Seema Rai was one of the potential recipients, she voluntarily got admitted to the hospital for the procedure.
The patient was evaluated by the nephrologist and the transplant surgeon who discussed the cadaver transplantation procedure with her family after which she, who was a teacher at an international school, along with her husband, gave the informed consent for surgery.
They did this after discussing the relative risks and benefits of surgery with the transplant team and also, over the telephone, with one of their relatives who was perhaps a doctor in the United States.
According to their nephrologist, the transplanted kidney was functioning very well but three days after the operation the patient developed a severe bleeding disorder called disseminated intravascular coagulation or DIC. This rare complication, which is known to occur after any major surgery or even the delivery of a baby, causes massive bleeding which is difficult to control even after transfusing many units of blood as well as blood products like plasma and platelets.
It can happen in the best of hospitals and a very famous film actress, Smita Patil who could have sought and afforded the best treatment anywhere in the world, helplessly succumbed to it after childbirth. Despite the best efforts, this patient too failed to respond and expired and her death cannot be said to bet a consequence of any act of negligence of either the transplant team or the hospital.
In another case, a patient was shown who claimed that a surgeon had amputated one of his toes needlessly. The ‘needlessness’ of this operation was revealed by another doctor only after it had already been performed. I fail to understand how the second doctor could give such an opinion when he or she had never seen what the problem was like before surgery.
In a situation like diabetic gangrene of one of the toes, a difference of opinion can be expressed only before the surgical procedure and not afterwards. No expert, however efficient and experienced can comment on the need for surgery or the lack of it after the condition has been treated.
No mention was made in the show of whether the patient was a diabetic and how well controlled his blood sugar was before the procedure.
From what I could see on the show, the foot looked like a classical case of diabetic gangrene that had been treated with the perfectly approved and appropriate treatment of surgical amputation. In fact, because healing can often be very slow here, it looked like the perfect answer to any diabetologist’s prayer about what the outcome of correct and prompt treatment should be!
Whenever truth is told, it should include the whole truth including the inconvenient bits. This show is not just unabashed ‘truth-telling’ but it aims to hammer the truth in after breaking it into convenient bits.
The whole exercise seems structured to appropriate for its lead star the role of being the truth-fountain. My worry is that he presents both a populist and ‘one-sided truth’ on an enormously complex social issue with a dangerous authority that only his kind of stardom can muster.
In his show, Aamir Khan has certainly taken a huge leap from simply raising the awareness of his audience to being a medical expert, interlocutor and activist all rolled into one.
Here he is not just making a fictitious film where he can manipulate facts to create a sensational effect on his viewers. Here he is sensationalising a real life situation in a reality show watched by very well-educated and even a technically qualified audience too in addition to the lay public that laps up as truth all that comes from the lips of their hero.
The show goes beyond a lay talk show, which at least pretends to allow different shades of opinion to argue, debate, agree or disagree with a situation. It only shows a blind judge without any qualification, showing his audience the subtle shades of differ-ence that lend charm to the sunset that his stardom dreads.
Await more comforting truths next week!
(K. Javeed Nayeem is a practising physician who writes a weekly column for Star of Mysore, where this piece originally appeared)