'Are you okay . . . I think we are losing her'
TIMELINE:This is the story of one woman’s death in an Irish hospital, based on the account given by her husband and friends
Savita Halappanavar was admitted to Galway University Hospital with back pain. She was 17 weeks pregnant. Seven days later she was dead. The hospital has said it cannot comment on individual cases and in relation to Ms Halappanavar, it must await the outcome of official investigations.
It’s a Saturday night, and Savita Halappanavar (31) and her husband Praveen (34) are holding a small get-together at their home in the Roscam area of Galway. It’s both a farewell dinner for her parents who are returning to India soon and an opportunity to announce to friends they are expecting a baby. Savita is 17 weeks pregnant. “Savita was very excited, very happy,” recalls Praveen. “All our close friends came to congratulate us.”
Early on Sunday morning Savita beings to feel uncomfortable and has to use the bathroom repeatedly during the night. By 7.30am, she has severe back pain. Praveen calls St Monica’s ward, the maternity unit at Galway University Hospital, and is told to bring her in.
She is examined and told there is nothing to worry about, that the baby is fine and she should go home and rest, her husband says. “We came back and had breakfast. Savita went to the toilet. I was still not finished with my breakfast. She came out and she had tears in her eyes. She said she had felt something hard. She looked in shock. She said, ‘Look, there is something wrong. I’m not well. We need to go’.”
The couple return to St Monica’s. Again, says Praveen, following examination by a midwife, she is told everything is okay. Savita insists on a further opinion. A registrar in obstetrics is called and he carries out an internal examination, finding her to be fully dilated.
At 17 weeks’ gestation her foetus is unviable and the couple are told they will inevitably lose the baby. “We just had time for ourselves so we talked. She just kept asking ‘Why did it happen to me? Why me?’ Because she was just so happy. ‘Why did God do this to us?’
“Then the doctor came outside and told me it would all be over in a few hours. I was concerned. I asked him specifically what he meant by a few hours. He said ‘maybe four to five hours. It will all be over and then you can go home’,” says Praveen.
Savita is taken for a scan and the foetal heartbeat is present. “She started crying and said she couldn’t take it. Immediately the midwife nurse turned off the monitor. Basically the foetus was still alive – she could see the heartbeat of the foetus. She couldn’t take it. She said ‘please, I can’t take it’. She was broken basically. Her heart was broken.”
Savita returns with her husband to St Monica’s that evening and is admitted.
On Monday morning the consultant gynaecologist who has taken charge of Savita’s care comes to see the couple. She tells them as the foetal heartbeat remains present no intervention is possible, says Praveen. At this point Savita makes her first request for a termination, he says. She has accepted the pregnancy is lost and wants the ordeal to end. He says the consultant responds that it is not possible but when pressed says she will “go and check and come back”.
Savita’s parents visit her. “She told them everything was fine, even though she was in a lot of pain. She was so bold, so brave,” says Praveen
At 4.30am Praveen leaves the hospital to bring his wife’s parents to Dublin Airport for their journey home to Belgaum in southwest India. Savita’s best friend in Galway – who does not want her name used – stays with her for the five hours he is away. She is still there when he gets back and the three wait for the consultant to come on ward rounds. The consultant comes to Savita’s room at about 10am. “Savita told the doctor she was anxious to know what the response was ,” says Praveen.
“The doctor said ‘unfortunately the foetus is still alive. It is law that we cannot terminate.” He says Savita pleaded for a termination to the miscarriage, by now in its third day. He then says the consultant said this was not possible, explaining to the young, Indian couple: “This is a Catholic country.” Savita, a Hindu, answers, “But I am neither Irish nor Catholic”, according to Praveen.
There are, according to Praveen, two junior doctors and a midwife also in the room – seven people in all – when this exchange takes place.
Savita begins to shiver, shake and vomit in the evening. When her husband calls a nurse she brings an extra blanket. Savita goes to use the bathroom but collapses. “There were big alarms, people came running,” says Praveen. “A doctor took bloods and started her on antibiotics.”
Wednesday morning and Savita is feeling worse. Praveen asks when the blood results will be back and is told it will be the following day, he says. He asks again for a termination of the pregnancy. Savita is anxious to get home, to contact her parents, to tell them what has happened before they started telling people at home they were to become grandparents. Again, he says, the request is refused.
That afternoon “at about 1pm” the foetal heartbeat stops. “It was kind of a relief for me. I thought she should be fine now and it will all be over in a few hours. We’ll go home.”
Savita is taken to theatre for an evacuation of her womb, which takes about 20 minutes. The consultant returns and tells him all the contents have been removed.
While talking he hears Savita crying in the theatre. “I rushed in and found Savita in tears. She said, ‘Honey, it was a girl’. A nurse there had told her it was a girl. She had wanted a girl and had thought of a name. She loved girls.”
A team from the high dependency unit is on standby and Savita is taken straight there. Her husband follows, and she asks him if her parents had arrived safely home. He tells her they have. That is to be his last conversation with her.
He goes home to shower. The hospital rings at about 11pm. “They said they were shifting her to intensive care. Her heart and pulse were low, her temperature was high. She was sedated and critical but stable.” He rushes back to find her fully sedated.
On Thursday morning Praveen speaks again to the doctor. He is asked if Savita had travelled recently or been in contact with farm animals, as the bloods indicated she had contracted E.coli ESBL, a particularly virulent strain of the bacteria almost wholly resistant to antibiotics, and septicaemia. She had not been anywhere unusual, he tells them.
“I didn’t know what septicaemia was. I assumed it was something to do with the shock that she went through when she found out she was miscarrying or when she found out it was a girl child. He told me she was critically stable. They were trying – she was on antibiotics – he just explained to me what they were trying to do.”
On Friday she deteriorates further. Praveen is told she is critically ill, but is “young” and “she’ll get over it”. “That was the confidence I had at the time. I thought she would be fine. I thought ‘she will come back at least for her father if not for me’.” She is, however, visibly very ill. “Her body had started swelling. She was looking big. Her tummy had bulged and when I touched her hand it was rock solid. She looked really, really sick.”
On Saturday things worsen and Savita’s heart, liver and kidney start to fail. There is talk of putting her on dialysis as she goes into multi-organ failure.
“The doctor asked me to come into his office and he had a chat with me. He said that he thought I should tell people – her folks and family – that she is very, very ill.” He goes to the hospital chapel to pray. At about midnight, a nurse comes to find him. “While we were walking the corridor she took my hand and asked me, ‘Are you okay to be next to Savita during her last few minutes? I think we are losing her’.
“I felt everything was just numb. It was the end of the world. Then I walked in and there was a big team around her. They were trying to pump her heart. The minute the doctor saw me, she came and held my hand and said, ‘You know what’s happening?’ I said yes. She said: ‘We are losing her. She is dying’.”
At nine minutes past 1am, Savita dies.