From Bombay to Baltimore!

Dr Bartley Griffith does Achanak again!!

The transplantation of a pig’s genetically coded heart in Mr David Bennett(57) at the University of Maryland, Baltimore has been creating flutters in the medical circles because of its scientific innovation and ethical issues associated with the tweaking of genetic programme of donor animals just to keep human beings alive.

The patient, Mr Bennett, has been a known case of severe breathlessness due to his poor cardiac functions and irregular heart rhythm, virtually bedridden for last many weeks and has been on heart lung bypass machine for his support. The drug treatment seemed not to be working on him with only heart transplant being the final option left for him to survive.

Dr Griffith with Mr Bennet

But he failed the suitability for a human cardiac transplant due to stringent organ transplant regulations of the US Government. Time and again, he had been off his cardiac drugs in the past and irregular with his cardiology follow up. It was assumed that giving a precious human organ, when there is a huge waiting list of recipients, to a reckless recipient like Mr Bennett would be the most injudicious use of the depleted donor bank. Keeping this track record of his truant patient in mind, Dr Griffith broached the topic with the patient in December 2021.

“We can’t give you a human heart. You don’t qualify. But maybe we can use one from an animal, a pig,” Dr Griffith said. “I wasn’t sure that he was understanding me,” he added.

Mr Bennett said,

” Well, will I oink?” He hoped, “ I look forward to getting out of bed after I recover.”

The rest is history with the surgeons team successfully transplanting a pig’s heart in a nine- hour long surgery.

As the tinkling of the ventilators recede and the circulatory support is being taken off, a maligned social history of Mr Bennett, has crept in from the backstage threatening to snowball into yet another socio-ethical debate.

Little did Dr Griffith know about Bennett’s troubled social past.

Edward Schumaker who was stabbed by Mr Bennett, pictured in 2003.

It was in 1988, when Bennett, then 23 years, in a fit of uncontrolled anger, had stabbed Mr Edward Schumaker (22) seven times in a Maryland bar when he saw Edward flirting with his then wife Norma Jean Bennet. Bennett was sentenced for ten years of imprisonment while Edward languished for many years in a wheelchair bound life before succumbing to the complications 19 long years after the attack.

Were the treating doctors justified in providing a life-saving surgery to a confirmed murderer?

The answer has been offered by Gulzar and Khawaja Ahmed Abbas half a century ago. Joining the dots of Bennett’s criminal record one is taken into a blood-curdling memory of a movie, Achanak, which I had seen in my school auditorium.

Achanak- Movie Poster

Remember Vinod Khanna, a beret-donning suave army officer who comes home to find his best friend in a compromising position with his beloved wife. The wife and her paramour are killed on the spot and Vinod Khanna is sentenced to death. But in an effort to escape from the police, Vinod gets gravely injured and lands up back in the police custody in a hospital. Should the doctors save his life, one who is a confirmed killer and is going to be hanged later?

Gulzar metes out a very humane treatment to a sensitive issue and presents a solution to a predicament which is now being faced by the doctors in Baltimore. Vinod gets to perform an endearing role where he reaches out to his treating doctors and nurses(including Farida Jalal) and draws sympathy from the audience though he has been labelled as a murderer. The doctors treat Vinod to recovery, only to lose him in the end to the impending death sentence.

Incidentally in 1959, a weekly tabloid Blitz, owned by R K Karanjia had published exclusive cover stories on yet another ‘crime of passion’. Commander Nanavati had used his navy revolver to shoot Mr Ahuja, Nanavati’s wife’s suspected lover, when Ahuja was caught in the bedroom of his flat purportedly coming out of his bathroom draped in a towel. Blitz painted Nanavati’s image, as that of a man representing middle class values as against Ahuja’s playboy image, that symbolised corruption and sleaze of the bourgeois. A copy of Blitz during the trial sold for Rs 2 per copy, up from the normal rate of 0.25 rupees. Peddlers in the street sold Ahuja towels and toy Nanavati revolvers! Nanavati was eventually pardoned by Mrs Vijaylakshmi Pandit, the then Governor of Maharashtra. Achanak was based on the true life drama of Nanavati’s case.

Time and again we as doctors face this ticklish issue where a convict lands up in our hospital for treatment. I must admit that the first reaction of all of us is to eye the convicted patient with suspicion. Most of his complaints are taken with a pinch of salt and it’s only after we have got a detailed appraisal of the patient’s history, that we believe in the true nature of his problem. Once through, we try to do our best to redress his or her complaints, giving no credence to his criminal record.

At the expense of sounding too simplistic, there is a clear cut separation of legal system from the healthcare system for good reasons. “The key principle in medicine is to treat anyone who is sick, regardless of who they are,” Arthur Caplan, a bioethics professor at New York University echoes. “We are not in the business of sorting sinners from the saints. Crime is a legal matter.”

Going a step further, Justice John Paul Stevens, from US Supreme Court stated in the footnote of the case Estille v/s Gamble, 429 US 97,(1976):”If a State elects to impose imprisonment as a punishment for crime, I believe it has an obligation to provide the persons in custody with a healthcare system which meets minimal standards care of adequacy.” Though, it clearly mentions that the convicts and prisoners have to be provided medical care, but it fails to define the minimal standards of adequacy.

So, when Dr Griffith suggested path breaking treatment to Mr Bennett, was he ethically and legally right to do so, when the law advocates just minimal standards of adequacy for such patients? The debate may degenerate into mudslinging brickbats but is amply summed up by Edward’s sister Leslie Schumaker Downey,

“They are putting Bennett in the storylines, portraying him as a hero and a pioneer.” “I think the doctors who did the surgery should get all the praise and not Mr Bennett,” she concludes.

As human beings first and doctors later, we confront this dilemma many times but over the years have come to realise that the same divine flame burns in the criminals and the haloed persons. The act of the criminal has to be separated from the person and compassion must flow for all including the criminals. A mature human transcends beyond good and bad as the reactions and the moral compartments are the stuff of a divided psyche not risen above personal mores.

The society definitely does not expect the healers to judge the patients and then treat them selectively. If that becomes a norm then the doctors shall become the judge, the jury and the executioners.

Following the similar philosophy of forgiveness and benevolence, a group of convicted prisoners and criminals were seen being lodged in an open jail in an effort to reform them unconventionally in Do Aankhen Barah Haath- the V Shantaram path breaking movie with a strong social message which incidentally also had the melodious prayer of the century “ Aye maalik tere bande hum” playing through the narrative.

And then there is Fyodor Dostoevsky, the Russian writer and philosopher who was banished to the Siberian prisons for four long years for his revolutionary publications and discussions of the books which criticised the Tsarist Russia. A writer who dealt with fragility and madness, wickedness and saintliness on the same page, Dostoevsky had explored the psychology of the prisoners leading him to believe that even the hardest of criminals had some good in his character.

The whole saga boils down to the age old saying,

“Every Saint has got a past and every Devil has a future!”