Aruna Shanbaug’s story is the story of rarest of rare nursing compassion, of dedication and of personal commitment to a professional colleague in her darkest hours. The nurses who tended to Aruna in her permanent vegetative state for over four decades need a national honour as they stand in a sea of messy, commercialised and insensitive healthcare that ails India. Four decades in bed and not a single bedsore! That’s the loudest applause in itself and KEM Hospital nurses deserve every single sound of it, says TN Raghunatha from Mumbai

There is no part of my life, upon which I can look back without pain

The amount of relief and comfort experienced by the sick after the skin has been carefully washed and dried is one of the commonest observations made at a sick bed.

Women should have the true nurse calling, the good of the sick first, second only the consideration of what is their ‘place’ to do – and that women who want for a housemaid to do this when the patient is suffering, have not the making of a nurse in them.

— Florence Nightingale

Aruna Ramachandra Shanbaug was helpful, kind, selfless and had in her abundant desire to reach out to the needy long before she took up nursing as a career,” Dr Anant Gaitonde who taught her Microbiology at the KEM Hospital way back in 1971, says.

“If a student sitting next to her did not have a notebook, Aruna would take out a spare pad from her bag and give it to him. I had noticed that both as an intern nurse and as staff nurse, she would attend tenderly to patients. If she saw an unclean bedsheet, she would change it for the patient instantly, something that normally does not happen in a municipal hospital,” Gaitonde, then a young lecturer and now in his late 70s, fondly recalls.

“Aruna was studious and good at whatever she did. She had enough dedication and all other qualities required for the profession she had chosen. She would have made an excellent nurse had her career not been cut short by that devil,” Gaitonde says.

Indeed. little did the budding nurse in Aruna know till the evening of November 27, 1973 when a wicked ward boy Sohanlal Walmiki gagged her with a dog chain and sexually assaulted her, that she would be reduced to a “Permanent Vegetative State” (PVS) from then onwards.

It was her good fate that her college colleagues, elderly nurses, ayaas and scores of others who opted for the nursing profession at the same hospital over the decades, took care of Aruna as lovingly and compassionately as a mother would till she passed away on May 18, 2015 — the same way as she would have attended to thousands of patients at the 89-year-old King Edward Memorial (KEM) Hospital had she not been assaulted.

It is an amazing story of nursing, especially because it has unfolded in the midst of a healthcare nightmare that India is. Nurses of all age groups — as also students from the nursing college attached to the hospital — joined the then Dean Dr Sanjay Oak and other doctors in opposing euthanasia for Aruna, when the matter came up before Supreme Court early 2011, in the form of a mercy killing petition filed by journalist-activist Pinky Virani.

Oak, now-vice chancellor of DY Patil University, Navi Mumbai, can’t stop talking about the exemplary role of the nurses in taking care of Aruna and keeping her alive for close to 42 years despite her being permanently vegetative. “You will not have any other case in world history of medicine wherein a patient was cared for and nurtured in a bed for close 42 years. This speaks volumes about the care that KEM Hospital’s nursing staff gave to Aruna,” he says.

For these nurses Aruna was family. “The caretaking was not seen so much as duty as a feeling of oneness. We used to introduce Aruna to every batch of student nurses and tell them that she was one of them and would continue to be so till her natural death. The student nurses would take care of her wholeheartedly. The manner in which the nursing staff treated Aruna is one of the finest examples of love, professionalism, dedication and commitment to ailing colleagues who cannot support herself. Not once in 42 years, the thought of putting Aruna to end her life and vegetative existence crossed the minds of these nurses,” Oak says.

Oak’s remarks are best seen in the light of the fact that Aruna had, till her death, lived in a room of Ward No 4 of general internal medicine and was well looked after by the 860 nurses who would attend to as many as 1,800 beds daily, in the busy hospital. About 18 lakh out-patients and 80,000-odd in-patients go through this hospital annually.

A three-member Supreme Court-appointed team of doctors comprising Dr JV Divatia (Professor and Head, Department of Anaesthesia, Critical Care and Pain, at Tata Memorial Hospital), Mumbai, Dr Roop Gursahani, (Consultant Neurologist at PD Hinduja Hospital, Mumbai) and Dr Nilesh Shah (Professor and Head, Department of Psychiatry at lTMG Hospital) who had examined Aruna on January 28 and February 4, 2011, had vouched for the excellent care given to her by these nurses.

“For the last so many years, she is in the same bed in the side-room of Ward 4. The hospital staff has provided her excellent nursing care since then which included feeding her by mouth, bathing her and taking care of her toilet needs. The care was of such an exceptional nature that she has not developed a single bedsore or fracture in spite of her bedridden state since 1973,” the team report said. This report was submitted to the apex court which was hearing Virani’s petition seeking grant of mercy euthanasia to Aruna.

Given that a majority of the nurses have at some point in time attended to Aruna, her death has left a big void in lives of nurses in the KEM Hospital.

“With Aruna not there, life will no longer be the same for us. She was part of my work life since 1976 (three years after the horrific incident that reduced her to a vegetative state). I had been assigned her duty for a few years in the beginning. later on from 2007 to 2009, as a senior nurse, she was again assigned to me. later on, as the nurse-in-charge, I was supervising Aruna’s care,” current nurse-in-charge Anuradha Parade says.

For Parade, tending to Aruna was like taking care of a four-month-old baby’s medical state. Oak says it was like dealing with Cerebral Palsy in a newborn. Oak was always of the view that Aruna was not in coma. Since Aruna’s brain was deprived of oxygen for a crucial period of time, she was in a state similar to that Cerebral Palsy in newborns.

“The 42-year-old routine was to give her a sponge bath twice a day and powder her. We would change her position on the bed every two hours. Till 2010, we would feed her normally through her mouth. Around that time, she was hit by Malaria. After she recovered from that, we began to give her semi-solids through the Ryle tube (a tube that is passed into stomach through nose),”Parade recalls. “Aruna looked happy once we gave her sponge bath and powder her. We could see a satisfied look on her face,” Parade recalls.

Current matron Arundhati Vellar, who has been at KEM Hospital since 1981, says: “I had known Aruna since the nursing college days. I had attended to her both as a student nurse and later as a staff nurse. In the last few years, I would visit her frequently during my daily rounds. She was not able to see or recognise anyone. But, if you touched her, she would feel the touch. The nurses on her duty – as also the ayaas — would look after all her needs”.

“Except for two brief illnesses — once in September 2010 and recently another time before her death — Aruna had never fallen ill in her 42-year hospitalisation. She never had indigestion, constipation or bedsores. She preferred to remain clean and hygienic. When she wetted her bed, she would cringe or shout so that nurses could go to her and change the sheets,” Vellar tells you.

The hospital’s senior-most nurse Surinder Kaur, who has been associated with the Hospital since 1976, said that Aruna ate chapatti and rice till 2010 and preferred fish and chicken. “She relished fish. She would smile at times when she was given fish. She would drink water. That’s why we would give her liquids mostly. But after the bout of Malaria, her oral intake reduced. We began feeding her semi-solid food like mashed bananas etc,” Kaur says.

She also loved to listen to devotional songs – like the ones rendered by Sadguru Waman Pai — whenever they were played for her. “Our nurses would speak to Aruna in Marathi. She could not speak, but she seemed to understand what we were saying. There were a few nurses who would speak to her in her mother tongue Konkani. She could not utter any comprehensible word. But whenever we would ask her to show her tongue she would do so,” Vellar recalls.

Oak says that Aruna was in a condition where her coordinator, sensory and motor functions in the brain were damaged and she had suffered from loss of speech and perception. “She was not able to stand or walk so in later years we did not attempt to do anything in that regard because she was fragile and we feared that she would break her bones. “Her eyes used to be open and she would blink frequently. But the eye movements could in no way be construed as a response to a question,” he says.

Aruna may have been by large healthy all through her stay at the KEM Hospital, but ageing had begun to show. “After 2010, she began to lose her teeth. Her hair had turned white too,” Vellar says. The nurses of the KEM Hospital have over the years been lavished with praise for the delicate manner in which they took care of Aruna. The bond became stronger after Supreme Court took cognizance of the fervent plea made by the hospital staffers, including nurses, to keep Aruna alive till her natural death.

In its landmark judgement of March 7, 2011, a two-member bench of the Supreme Court comprising Justices Markandey Katju and Gyan Sudha Misra  observed: “In the present case, we have already noted that Aruna Shanbaug’s parents are dead and other close relatives are not interested in her ever since she had the unfortunate assault on her. As already noted above, it is the KEM hospital staff, who have been amazingly caring for her day and night for so many long years, who really are her next friends, and not Ms Pinky Virani who has only visited her on few occasions and written a book on her. Hence it is for the KEM hospital staff to take that decision.

“We do not mean to decry or disparage what Ms Pinky Virani has done. Rather, we wish to express our appreciation of the splendid social spirit she has shown.... All that we wish to say is that however much her interest in Aruna Shanbaug may be, it cannot match the involvement of the KEM Hospital staff who have been taking care of Aruna day and night for 38 years.

“We also commend the entire staff of KEM Hospital, Mumbai, (including the retired staff) for their noble spirit and outstanding, exemplary and unprecedented dedication in taking care of Aruna for so many long years. Every Indian is proud of them,” the two judges said. After the apex court turned down Virani’s mercy killing for Aruna, the nurses began to celebrate Aruna’s birthday (June 1) regularly. Unfortunately, Aruna will not be around for her 67th birthday on June 1, 2015 – on which the nurses and all other staff members are planning to organise a memorial meeting for her.

Aruna may not be around in flesh and blood, but she has left behind her an inspirational story around the nurses who cared and tended to her selflessly. And that’s an amazing story in itself — amazing, inspirational and a rarest of rare feat which needs to be honoured at the highest pedestal.