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Fighting For Life

Sonia Chopra

On last May 28, Kunal Saha, watched the heart monitor attached to his wife at Breach Candy Hospital in Mumbai. As Saha, a scientist and physician, watched the lines go flat, he realized that his wife Anuradha had died.

Yet, in the moments that followed, he went through an experience that defied everything he had learnt in science. He believed that his wife communicated with him.

He heard her voice say, "This was meant to be. I came into your life for a purpose. My dying too, has a purpose. It is up to you to stand up and raise your voice so that the thousands who are dying in our motherland may be saved."

"It could be a hallucination but that is what happened that day," says Saha, MD, PhD, and an assistant professor at the department of pediatrics, medical microbiology and immunology, Children's Hospital, Columbus, Ohio.

Eighteen months after her death, Saha has made headlines in India newspapers because he has initiated a lawsuit against the three doctors in Calcutta who allegedly have wrongly prescribed steroids to his wife, causing her death. They tried to squash their indictments but, on October 25, the appellate court of India rejected their plea and ordered them to stand trial, Saha says.

He has asked Rs 77 million and says he will use the money to help charities in India and help to empower Indian patients.

The conclusion that the doctors were negligent came after months of painstaking research by Saha and with confirmation from other researchers.

" I've been searching these answers regarding the adverse effects of steroids in relation to a personal tragedy that has changed my life forever," Saha says.

"I've personally gone to the top experts all over the world and almost all of them expressed their disbelief at the treatment that my wife received in Calcutta," Saha says.

The story in brief: Anuradha Saha, 36, a recent graduate in child psychology from Columbia University, New York went to Calcutta with her husband for her brother's wedding. They left in April.

"We were taking a break before the next phase of our lives," says Saha, who had accepted a tenure-track faculty position to build an AIDS center at the Ohio State University at Columbus.

"We took three trips to see the place, picked a house and signed up for a joint mortgage. We were excited and happy. It was going to be a picture perfect life," says Saha, who often told friends that he "had one leg in heaven" after marrying Anuradha.

They arranged to move their furniture and belongings from their Forest Hills, Queens home to their new home.

After a few days in Calcutta, Anuradha developed a cold, a fever and minor skin rash. On April 19, it didn't look too serious. However, after a week, the skin rash looked like it had spread. The family was concerned and they fixed up an appointment with Dr Sukumar Mukherjee, who had the reputation for being the best in town.

"People waited in line to see him. They had appointments weeks in advance," says Saha, who was also born and brought up in Calcutta. He graduated at the top of his class from Nilratan Sarkar Medical College. Some of his friends and professors in the medical community too testified about Mukherjee's reputation.

"We were thinking of starting a family after we came back here. Our lives were just beginning," says Saha, who immigrated to the United States in 1985. He met Anuradha, an American citizen and a student in California, when she was visiting her family in Calcutta. They were married there.

The skin rash was diagnosed as Toxic Epidermal Necrolysis, an immune disorder. By May 4, Anuradha's condition worsened. Saha, who was a researcher and did not practice medicine, was not conversant with rashes but he did question the use of steroids that Dr Mukherjee insisted was the treatment now.

"I had my doubts right from the beginning. I know steroids are very controversial in the US and most doctors do not prescribe it," he says.

Even as he watched Mukherjee inject his wife with 80 milligrams of Depo-medrol, he felt very concerned.

"I have never used this preparation and I never understood why this extraordinarily long-acting preparation was used for an acute skin condition," he says.

"Nonetheless, Dr Mukherjee said that he had used it with great success in similar cases before," says Saha, who consulted his medical school colleagues. They echoed his concern but reassured him that Mukherjee was known to be the best.

Mukherjee prescribed 80 milligrams twice a day. Over the next five days, 800 mg of Depo-medrol was given to Anuradha. Months later, in correspondence with Pharmacia-UpJohn in the US, the makers of the steroids, Saha would learn that the correct dosage was 40 to 120 milligrams once every two to four weeks.

After six days of this Anuradha 's condition worsened: her skin came out. She was admitted to the Advanced Medical Research Institute (AMRI).

"I was frantic. I was calling Mukherjee hourly by now. I desperately tried to take her to the US. I even booked the tickets three times but everyone persuaded me to wait," Saha says.

"Even Mukherjee told me in front of Anuradha, 'Your wife will be okay. Why do you want to take her in a plane? She will be tortured. Don't worry, she will be fine','' he recalls.

"After Anuradha heard that, she said, 'I'll be fine, honey. This isn't your field, you don't practice this, you don't know anything about this, don't be nervous. I will be fine'," Saha recalls.

Saha said patients with TEN are treated in sterile environments like burn victims are because the skin loss is similar. They are also given fluids intravenously. Mukherjee consulted other doctors, Abaci Roychowdhury and B N Halder.

But, instead of using the accepted protocol used with TEN patients, they did not suggest a sterile environment and advised against giving her IV fluids, an important requirement because skin loss leads to serious dehydration. They suggested Anuradha drink the fluids though her mouth was swollen and full of sores.

She swallowed between one-two liters of fluids as the doctors suggested when four-seven liters of fluids were necessary, Saha says. They also prescribed more steroids, 120 mg per day of oral prednisolone, which was also excessive, he says.

Finally, Saha says, the doctors advised against any dressings for the skin, which was soon attacked by bacteria.

"By May 16, Anuradha was more dead than alive," adds Saha, who, in a final desperate attempt to save Anuradha, moved her to Bombay in a chartered plane.

On May 28, she died.

The cause of death was listed as septic shock with systemic candidiasis, a frequent side-effect of excessive steroids.

"I've lost everything. I feel cheated, betrayed and lost," says Saha, who returned to the US after his wife was cremated in Calcutta, the city of her birth.

"I know that I cannot bring my wife back and that she had to depart from this world at such a young age only because of the lack of current knowledge in medicine," Saha says.

The lawsuit which resulted in the indictments of the three doctors and, seeks compensation of Rs 77 million is Saha's way of honoring his wife.

"An even bigger honor to her of course will be when thousands of patients in India will not lose their lives any more, simply because of the ignorance and arrogance of these 'top' Indian doctors," Saha says.

"My wife was the reason for my success, my prestige and why I am now at the cutting edge of research." Saha says.

The money that Saha will receive if he wins the lawsuit will go to medical research and children in India.

"My only goal is to make these doctors more knowledgeable about the practice of medicine so that more innocent lives may not be lost in that part of the world," Saha says.

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