It has been 70 days since Jayalalithaa has been at Apollo Hospitals in Chennai. When she was moved out of the Critical Care Unit to a normal ward last week, it was seen as an indication of a remarkable turnaround. An ebullient Apollo chairman Prathap C Reddy had said that it is for Jayalalithaa, who was undergoing physiotherapy, to decide when she wants to go home.
Things turned terribly wrong on Sunday evening when the Tamil Nadu chief minister suffered a cardiac arrest. Sources indicated that she was rushed back to the CCU, put back on the ventilator and revived but remains very critical.
On ECMO Support
Apollo Hospitals says Jayalalithaa is on ECMO (or extra-corporeal membrane oxygenation device). This is a technique of providing both cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. It is a life-sustaining intervention and it gives an idea that things may be back to square one for the CM, back to when she was admitted to the hospital.
Along with the terse Apollo press release and tweets, it is the fast-paced developments outside that are worrying the agitated AIADMK cadre. Many of them are extremely emotional and have thronged the Apollo Hospitals road. On the narrow Greams Road in Chennai, where the hospital is located, handling thousands of party cadre and media has become a tough task.
More Than What Meets the Eye
The first indication was Union Home minister Rajnath Singh asking Governor C Vidyasagar Rao to rush from Mumbai to Chennai. Rao is the Governor of Maharashtra and holds additional charge of Tamil Nadu.
Sources say Rao has been asked by the Centre to get a first-hand assessment of the situation and report back. Rao’s report will be critical to the manner in which the NDA government proceeds in Tamil Nadu.
The second indication was the presence of several senior ministers including finance minister O Panneerselvam at the hospital. Other MLAs also joined in and reports suggest an emergency informal cabinet meeting also was held to take stock of the situation.
The third indication was the party asking all AIADMK MPs who were to take the Monday morning flight from Chennai to New Delhi to cancel their tickets. Those who had reached Delhi on Sunday were asked to return. Since 22 September, when Jayalalithaa was admitted, these kind of instructions were never issued.
Four, the Tamil Nadu police force was put on high alert.
All police personnel in the districts, including those from CID, have been asked by the DGP to report to their respective police stations by 7 am on Monday.
Unconfirmed reports suggest that opposition leaders like MK Stalin have been asked to cancel their public engagements.
In the last one month, the Tamil Nadu administration was under the care of finance minister O Panneerselvam, with Jayalalithaa as chief minister only in name. But Sunday's sudden development means Tamil Nadu is fraught with its toughest dilemma. Which explains the flurry of reactions from all over the country, indicating that there is perhaps more than what meets the eye.
Vulnerabilities of an ARDS Patient
One of the reasons why Apollo was very circumspect about the kind of recovery Jayalalithaa had made and not announcing it to the world was because an ARDS (Acute Respiratory Distress Syndrome) patient, even when he or she shows dramatic improvement, is deemed vulnerable.
ARDS is a life-threatening medical condition, characterised by inflammation in the lungs. ARDS is triggered by pneumonia and sepsis, one of the reasons why intensivist Dr Richard Beale, an experienced investigator in the field of sepsis, ARDS and clinical nutrition, was flown in from London to treat the CM. An intensivist by definition is a doctor who specialises in treating critically ill patients.
Experts point out that ARDS is known to have a high mortality of up to 50 percent. When it is accompanied with other ailments, it only complicates the issue and the treatment. In Jayalalithaa's case, her diabetes, hypertension and cellulitis — ailments mentioned in her 2014 bail plea at the Karnataka High Court — were factors the team of doctors took into account. If the patient is young, the body recovers much faster. Since the CM is 68, she needs that much more care.
Given her medical history, doctors have been of the opinion that her recovery so far has been remarkable. But Sunday's cardiac arrest has been a setback.
(The writer is a senior journalist. He can be reached @Iamtssudhir. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)