Aruna Shanbaug, the former nurse at King Edward Memorial Hospital Mumbai, who had been lying in a vegetative state for the past 42 years, passed away at 9.40 am on Monday. She had been fighting pneumonia for the last six days, doctors at KEM Hospital said.Shanbaug was rendered paralysed after a brutal sexual assault in 1973 and a room outside ward 4 had been her home since then, with the medical staff of the hospital resolutely standing by her, attending to her, even opposing the petition by her friend journalist Pinki Virani for allowing the former nurse to die.Virani wrote a book on Aruna's life after Shanbaug's rapist served sentences for assault and robbery and was freed after seven years. but not for rape. The more serious charge of sodomy was never pressed on him and it was not considered rape under Indian laws at the time.Virani later petitioned the Supreme Court in 2009 that Shanbaug was "virtually a dead person" and should be allowed to die as the "continued existence of Aruna [was] in violation of her right to live in dignity". The hospital authorities told the court that Shanbaug "accepts food... and responds by facial expressions" and responds to "commands intermittently by making sounds".On January 24, 2011, after Shanbaug had been in this state for 37 years, the Supreme Court of India responded to Virani's petition for euthanasia by setting up a medical panel to examine. But on March 7, 2011 it turned down Virani's petition as as she was "not a relative" of Shanbaug and nor could "she claim to have such close emotional bonding with her as the KEM hospital staff.""No doubt Ms. Pinki Virani has written a book about Aruna Shanbaug and has visited her a few times, and we have great respect for her for the social causes she has espoused, but she cannot claim to have the extent of attachment or bonding with Aruna which the KEM hospital staff, which has been looking after her for years, claims to have," the court observed.But the same landmark judgement went on to allow passive euthanasia in India, ruling that life support could be legally removed for some terminally ill patients in exceptional circumstances, providing the request was from family and supervised by doctors and the courts.The following extracts are from Virani's book,***1.20 p.m. Dr Sundeep Sardesai closes his books in his room on the KEM campus, takes off his spectacles and rubs his eyes. His MD examinations are barely two weeks away, there is still a bit of the syllabus to revise, though he has paced his studies quite well. His breaks have only been for meals, and that snatch of time with Aruna. He smiles to himself. That woman, she is like a child at some moments. But enough, he’s meeting her at 4.00 this evening. Now down to lunch in the canteen and back to these books.Some of the doctors stop eating and stare at Sundeep as he enters the canteen. At another table a lady nudges a man and gestures with her chin towards him. He is oblivious, he sits at a table with his stainless steel thali and begins eating methodically, chewing rhythmically. He is almost through his meal when a fellow MD-student walks up to his table hesitantly, ‘Hello Sundeep, you’re okay?’He is mildly surprised, ‘I’m fine.’‘Uh, uh, okay. Let me know if you need anything.’Sundeep spoons some vegetable into his mouth. ‘Need anything? For what?’‘Uh, nothing in particular, just … Anyway I have to go, bye.’The friend turns to leave, changes his mind. ‘Yaar, we all know that you are a calm sort of fellow. But how can you be so cool at a time like this?’‘It is difficult yes, but why should the exam make me, or you, hysterical?’The friend stares at him with horror on his face. ‘Sundeep, no one has told you? Your wife … uh … fiancée … oh hell … yesterday evening staff nurse Aruna Shanbaug was badly beaten up in the CVTC. He even tried to strangle her and, uh, uh … there is a suspected uh … you better see the dean.’‘How is she now?’‘Not good. But she has very strong will power. She was found only this morning, by then anyone else in her place would be uh … you want me to come with you to the Casualty?’Sundeep shakes his head, ‘It’s okay, thanks. You carry on.’ He looks down at his plate, there are the last spoons of dal- rice left. He eats them slowly, he’s thinking of September when he received his first big blow, this is the second shock within sixty days. The spoon scrapes the empty thali, Sundeep pushes it away, gets up from the table and walks slowly, as if in a daze, towards the rear of the main hospital building. The dean should be in his bungalow.He is. He looks carefully at the young doctor, sits him down on the sofa and asks for a cup of tea, with extra sugar, from the kitchen. He does not speak until Sundeep has had a few sips.‘Dr Sardesai, you have heard?’‘Why didn’t anybody come and tell me in the morning?’‘Ah yes, maybe they were looking for you?’‘Looking for me? I was in my RMO quarters, studying. No one came to find me.’‘Dr Sardesai, you are here now. It is for the best you were not around when the police were questioning everybody.’‘I don’t understand.’‘She is badly injured, there is a suspect but the police have to complete their investigations in their own way. Why should you have to spend a lot of your time being questioned by them when you have the most important examination of your life in two weeks?’‘Has she been … raped?’‘Yes.’Sundeep stands up, the cup still in his hand, ‘I have to go and see her, I have to see what I can do to help her. I should have been there in the morning.’The dean takes the cup from Sundeep’s fingers and sets it on a low table near the sofa. ‘Son, the best doctors in the business have examined her, don’t worry about the treatment. Tell me, have you met anyone from her family, her sister in Bombay perhaps?’‘No, never.’‘You never met anybody from her family?’‘She never really spoke about her family, I got the impression she did not want to. So I never bothered. In any case, it did not matter. But, yes, I do know her cousins.’The dean replies, ‘I ask from the medico-legal point of view. If we have to run any other tests on staff nurse Shanbaug we need the written permission of an immediate relative of hers.’Sundeep shakes his head in bewilderment. ‘I will give the permission and sign the forms, she is to be my wife soon.’The dean pats him on his shoulder, ‘Sit down. Have another cup of hot tea with me. This one has turned cold. She will be shifted to neurosurgery in a short while, under Dr Dastur. You can see her there. By then the police will also have left the premises. So tell me how are the preparations for your MD exams, what are you specializing in? What are your plans for the immediate future?’The dean is trying to tell him something, Sundeep understands this. But what? And why won’t he just say what he thinks he should in so many words instead of beating around the bush? Sundeep exhales, concentrates on marshalling his thought processes into their normally streamlined channels. No point getting all worked up over a fait accompli, it is best he maintain his equilibrium and cross each bridge only when he reaches it.~~~1.50 p.m. A crowd outside the matron’s office. Raised voices, knots of angry nurses. ‘This is not good. It can happen to any of us tomorrow.’ ‘What are they going to do about what has happened to Aruna Shanbaug?’‘I have confirmed that she was raped.’‘How can you say that with one hundred per cent certainty, Prema. Aruna is in a coma, only when she comes out of it will we know exactly what happened.’‘That is right. Besides, I went and saw the gynaecologist’s report after Aruna’s initial examination. It specifically says hymen intact.’‘It was not that kind of a rape.’‘What rubbish are you talking Prema? What other kind is there?’Sister Prema Pai hesitates, then speaks because she knows only the nurses will pay attention. ‘I will not name him, I spoke to another doctor who also examined her. He told me about it. He also told some higher- ups who ignored what he said. She was raped … the other way.’ Sister Pai starts weeping.Shocked silence, a few nurses comfort Prema. There is a whisper, ‘You mean, the way the dogs do it?’‘No, that’s unbelievable!’Another voice asks, ‘Prema, has she been examined completely for what you are saying has been done to her?’Prema shakes her head, ‘The doctor was very thorough in examining Aruna. He was medically convinced so he said he wanted to confirm one hundred per cent what he suspected and put down his findings on paper. Permission was not granted.’‘But why?’There is another voice, ‘Because the case is bad enough the way it is, the higher-ups don’t want it to look even worse.’‘Look? This is not about how anything looks. This is about us, human beings, women, professional nurses. It is about our safety. Tomorrow if something happens to another one of us, even the police will not be called because of how it will look?’‘Possible. There might be another kind of cover-up at that time. I think we will have to look after ourselves, to make sure we are safe and unharmed.’‘But how, and what can we do now about Aruna’s rape?’‘We will have to wait till Aruna herself speaks. Meanwhile we should immediately go on strike.’‘Strike? Like how the mill workers go on strike? But we are nurses!’‘Yes, let us go on strike. Let the authorities understand how serious this entire situation has become.’‘But we have no written proof that Aruna was raped. Suppose they ignore us?’‘They cannot. They know the truth. They know we know the truth.’‘Yes, let us go on strike. We need to press for security for ourselves.’‘That is right. We have to look after our own interests too. There should not be another Aruna.’Within the hour the nurses’ strike is total. Perhaps this is the first time since India attained independence that nurses have struck work, there are no records to suggest otherwise, nor memory. Certainly, this is the first time in KEM’s illustrious history that there is any kind of strike.Sister Shashikala Vaaran looks into the future, ‘Everything changes after this. Nurses henceforward will stop thinking of their jobs as anything beyond their shifts.’***The following is an edited version of an author-signed essay, highlighted on its cover which appeared in a national newsmagazine, a few days after the Passive Euthanasia Judgement and Law was passed in March 2011.Lucknow airport. Late ’90s. Khushwant Singh and I are waiting for our flights, we talk about Prime Minister A.B. Vajpayee mentioning my book Once Was Bombay in a speech on collapsing cities. He suddenly asks, ‘You wrote that book on the woman who neither lives nor dies, you still see her?’I say I’m banned by the hospital. Nothing new for me, though. Each time egos change – deans, doctors, matrons – I’ve redone the process with these authorities to stay in touch with Aruna Shanbaug. It’s a pattern since 1982.This time I should have been grateful for infrequent consent to visit her locked room. Instead, I had questioned their mandate. I had reported to newspaper editor Bachi Karkaria that the doctors had violated Aruna’s right to live with dignity. They had withdrawn permission for her complete medical check- up. Granted, as it were, after my physical and telephonic running around for several agonizing days.The full medical in a private hospital, at no cost to this municipal hospital, would have inspected Aruna from head to toe. Testing would have ranged from blood–routine to vital organs and a brain-scan. A skilled anaesthetist would have made the procedures painless for Aruna. Her rotting teeth, due to infected gums, would have also been dealt with. An ambulance with a private doctor would have picked up Aruna in the night since she had not felt sunlight for more than two and a half decades. I also signed a letter taking all responsibility.The idea, after the complete examination, was to consult top medical minds. On their recommendation for follow-up treatment, my husband Shankkar Aiyar and I planned to approach the Bombay High Court and point out that since Aruna’s medical care was at the mercy of a doctor-bureaucracy which had not conducted any further tests on its own, we were willing to be appointed guardians. We would buy the best medicines, ensure the treatment.Aruna is denied the medical tests, permission withdrawn at the last hour. Reason given? None. After much angry persuasion, the response is the same as that given by the nurses when preventing her from receiving physiotherapy:‘Supposing something happens to her?’Aruna Shanbaug. Sodomized. Strangled with a dogchain while being brutalized. Extensive brain stem injury, almost brain-dead. Cortically blind. Cannot speak. Or walk. No control over body movements. Administered mashed food, swallows automatically, upchucks equally. Teeth loosening and falling – one by one – on her bed. In pain. Shrieking. Howling. Weeping. Laughing manically. After the initial days, no medicines prescribed by the doctors, so none given.Abandoned by friends; authorities don’t encourage their visits as they are not blood relatives. Abandoned by relatives; they are constantly told by this free hospital to ‘take her home’. I’ve been told too. I would if I could; but it doesn’t change the fact that Nurse Aruna Shanbaug has every right to remain in that hospital. Hers is a case of aggravated sexual harassment and assault in the workplace. The hospital would have had to pay large cash-compensation plus provide permanent care had her relatives been well-educated, not poor, and had access to a responsive legal system.Abandoned, too, by municipal doctors; and here is supreme irony. The daily devotion of her colleagues has been so systematically thrust upfront, that it has successfully masked Aruna’s medical mismanagement by key municipal doctors. The main medical man manipulating the media has this to say to reporters equally keen to romanticize Aruna’s condition,‘Whenever I go to her room I take her blessings’. Hypocrites also take Hippocratic oaths. After Aruna was brutally assaulted, no doctor at the hospital was willing to file a complaint that drew attention to the fact that she had been anally raped, even though there are now claimants to ‘being there first to treat her’. The result: the sodomizer walked free after a mere seven years in jail for robbery.And so; equally abandoned by the law. Aruna Shanbaug. Born 1 June 1948. Murdered-but-not-killed 27 November 1973.Khushwant Singh asks his second question, ‘You think there is a God?’~~~I’m standing below the flag of India that flies above the main dome of the Supreme Court. I look up at it. If God has abandoned Aruna too, can’t we at least ensure that her pain is validated by her country?My plea as the ‘next friend’ for her, and every Indian in a similar condition, must have been admitted by some divine force listening in just then. For the Supreme Court decides to accord that dignity to Aruna Shanbaug which has been denied to her for more than three and a half decades.The plea simplified: Please define Right to Live with Dignity as enshrined in Article 21 of the Constitution. And if this is not it, please taper out the force-feed as per prescribed international standards.2011. Because of the Supreme Court’s orders, after thirty-seven years Aruna Shanbaug gets what she should receive annually: a medical check-up.If I were consulted, I would have recommended two doctors. From UK, where vegetative pain management intertwines with compassion. From Liege, where research combines with machines to evaluate levels of patient consciousness.The medical report confirms that she fulfils most criteria of those in a permanently vegetative state. Such patients do not have favourite foods, music, people. Their smiles are not reactions to external influences. She is incurable.But Aruna Shanbaug must not, cannot, die. Not when there are medical names involved in this medico- legal case. There are promotions, file- markings, resident- quarters, spacious flats in prime residential areas. Everyone can move on to private practise or retirement, none need return to her locked room. With Aruna alive there is more power, more media attention, international conferences. And so they play their politics around the motives of mercy in medicine.The medical report comes with a brief CD on Aruna as she is today. It is shown in the packed court-room.The main medical man has ensured a battery of lawyers, none paid for by him. The might of the state against the individual starts its road-roller grinding.Look, no bed sores.Listen, she is not completely brain-dead or she will not be making those noises.See, she moved. She is not in a full-coma.Cures are being found everyday.When the state is looking after the suffering, outsiders need not be concerned.It is against Bharatiya sabhyata.My poor, poor Aruna. All I have, standing in this one corner of the court, is my choice to be morally accountable for you, no matter the consequences in the court of God.And then, his voice cutting through the clutter of righteousness, I hear the judge use the words ‘Passive Euthanasia’.This, too, is how landmark judgements come to a country.Please see the Supreme Court website where it has been uploaded. Please see whether the court thinks Aruna’s current situation is a ‘life’ even though it rules she must ‘live’. The status-quo of the state (in this case, the care-givers) as decider of her fate has been maintained, but do see if there’s anything which tells them they can approach the High Court should they ‘change their mind’.Meanwhile, because of this broken woman denied the choice, all of India has one. Passive Euthanasia is legalized and becomes Law for both, brain- dead patients and those in a permanent vegetative state. None need suffer the way Aruna Shanbaug has. And continues to.That CD shown in the court? It is so gruesome that even the generally no-holds barred regional television channels are unable to run it in full. Thus, what the media carries is the picture on this book’s cover; the one I copied and carried of a sixteen-year-old girl who had framed it and put up in her village home before she left it.The mid-sixties-old reality has been locked away. Always in pain, no palliatives prescribed. No teeth. White cropped hair. A feed- pipe running from her nose to her stomach. Feral sounds from a twisted and brittle skeleton. From which finger nails continue to grow, cut into her palms. Prone to diarrhoea, yet no catheter. Doomed to a very painful, and very slow, death.Aruna Shanbaug. Prisoner of the state; held hostage by the quality of its mercy.