Losing The Heart

The sudden death of reporter Mudasir Ali has not only spotlighted the stresses and insecurities in media but opened up the issues of heart and soul for a wider debate yet again. Saima Bhat reports the increase in the incidence of sudden deaths, mostly the cardiac arrest, and how experts see the phenomenon 

Mudasir Ali

On November 20, early morning, a large number of vehicles were en route to Chrar-e-Sharief, a place which is home to one of Kashmir’s holiest shrines. In between the sirens and speed, there was silence. The destination was the home of Mudasir Ali’, one of Kashmir’s finest reporters who died in the night (November 20) due to cardiac arrest.

 Final Journey

 Ali, 37, was doing his routine work on Thursday night. His mother told his colleagues that she was with him till 1 am. But around 2.30 am he had called his mother.

 “I  went to his room. He was writhing in chest pain. He asked me to save him,” reported Greater Kashmir.

Panicked, the mother called her another son, Jehangir Ali, also a journalist. The family immediately shifted Mudasir to a nearby sub-district hospital, which was just a few meters away from his house. The doctor on duty, not able to treat and revive Ali as per the family had referred him to SMHS hospital. It took family 50 minutes to reach Srinagar, but Mudasir had lost the battle. Doctors at Srinagar hospital declared him dead on arrival.

But one of his friends informed Kashmir Life that he was dead in initial 10 minutes when they were at SDH Chrar e Sharief. Mudasir, he said, was lost in the golden hour.

Negating the version of the doctors, one of his friends, also a doctor, said Mudasir may have actually died of ‘pulmonary thromboembolism’, which he said is rare at such a young age.

“He had met an accident and his leg had got fractured. After removing the cast, he still had swelling in the leg. I think his symptoms which he had informed his family about like breathlessness and pain in the chest could have been because of that. I wish the doctor at SDH had given him Heparin and put him on oxygen, he could have been saved,” the doctor said adding that he was athletic, used to play cricket and never complained of any health issue.

Professional Stress 

Mudasir’s sudden death is not an isolated case that has happened in Kashmir media industry. Just 50 days before his death, Javid Ahmad, 31, a resident of Watergam (Rafiabad), who was working as a defence correspondent of Rising Kashmir, also passed away suddenly. He had a cardiac arrest when he was on his way to Srinagar on October 1. Travelling in public transport, he collapsed when the vehicle reached Pattan. Once taken to a nearby hospital, the doctors declared him brought dead. Later doctors said the cause of death was cardiac arrest.

Javid Ahmad, Kashmir reporter, who died of heart attack in 2020.

Shockingly, both the reporters were below 40 years of age and none of them had an underlying medical crisis that could be linked to their heart problems. Reportedly they were neither smokers nor had any issue of job insecurity. Earlier in March 2018, Maqbool Sahil, an Urdu journalist, also met a similar fate while he was riding his bike.

Concerned over the situation of young journalists meeting such a fate, it is believed that people associated with this profession across the globe live highly stressful lives. “The hearts of our youthful friends and colleagues are stopping suddenly,” journalist Muzamil Jaleel wrote on his social media handle.

Muzamil Jaleel

“There is so much grief in our lives. There is so much unbearable pain that we see and feel every day. Living, working, existing is a never-ending struggle. And the good among us, those who aren’t numb already, can’t take it anymore. When will we start living again, when will our land stop seeing the frail shoulders of parents carrying the coffins of their young children…when will we resume dying of old age…when will we start telling the happy stories.”

As per a study, it is reported that roughly 30 per cent of heart attack victims are from high-stress, white-collar jobs.

Dr Arshid Hussain, Professor, IMHANS Kashmir

Dr Arshad Hussain, a professor in psychiatry at SMHS’s Institute of Mental Health and Neurosciences said working in conflict zones has never been easy and for journalists, it is even more difficult. He further said it becomes more traumatic when one has to report pain.

“Journalists are the first ones who witness the tragedy and then they have to report it,” Dr Arshad said. “It becomes difficult for them to give a vent to their own feelings. They hardly get time to do that.”

Journalists hold a protest rally against barring of photojournalists from R-Day function on Saturday, January 26, 2019. KL Image by Mehraj Bhat

Working with journalists for more than two decades, Dr Hussain said they are a bit more stressed than other professions but quite a few of them seek professional help. “This job is timely, means they have deadlines for everything, and then even after performing up to the mark, they have insecurities about their jobs and salaries, which has increased in last two years. There have been layoffs in the media industry more than any other profession. It is like a double-edged sword,” he said. “Journalists in 90s have seen more of the conflict but they were not stressed as much as the present-day lot is, which indicates job insecurities are there.”

Sudden Silence 

Mudasir is not the only person who died of a sudden heart attack and media is not the only area where such deaths take place. Around 17 million people die suddenly, mostly because of cardiac arrest, annually across the globe. Sudden death in a healthy person, doctors say is within one hour of onset of symptoms.

Representational Image.

“In the US, there are 3.2 lakh sudden cardiac arrest deaths every year. In Kashmir as well these deaths do happen,” said Dr Imran Hafeez, a known cardiologist working at SKIMS. “Now it is getting more attention because of being reported in social media. But yes the fact remains, there is also an increasing trend in such deaths from some time now.”

Dr Imran Hafeez

However, Dr Hafeez blames coronary heart diseases to secondary diseases like cardiomyopathy, which means rhythm disturbances which can lead to sudden death. He said other diseases like cardiac channelopathies, which also has rhythm disturbances, hypertrophic cardiomyopathy which happens to athletes and young, also lead to sudden deaths.

Explaining the phenomenon, Dr Hanif, working at a Delhi based hospital said heart attack should not be confused with sudden cardiac death (SCD). The SCD, he said, is “unexpected natural death from a cardiac cause within a short time period. It consumes victim out of blue and leaves little to be done for the revival.”

Heart attack, he said, results from acute blockage of a major blood vessel of the heart, leading to injury or death of a portion of the heart muscle, and added “though even heart attack can lead to sudden cardiac death, but the two terms are not the same.”

The situation which emerges at the time of SCD, Dr Hanif said, is almost 45 per cent without a witness and at times the bystanders see the fall. It, he said, may occur as the first manifestation of heart disease in a previously healthy individual. “The symptoms of the SCD are immediate, drastic, not conventional and include sudden collapse. It accounts for up to 50 per cent of all cardiovascular deaths occurring worldwide annually.”

 The Cause

Three decades ago, Kashmir was not known to cases of sudden deaths. However, the cases were rampant in western countries. But as frequent deaths were reported, the doctors there worked on it and controlled the death.

In Kashmir, over the past few years, the cardiologists have been noticing a worrying trend: the number of heart-attack cases among 30-40-year-olds is on the rise.

Dr Hafeez said this trend is now prevalent in Southeast Asia. Recalling a population-based study, he said the average age of heart attack in Southeast Asia was 53 and the rest of the places it was around 63 because most of the people here are having Coronary heart diseases, and the main reasons for that is hypertension, diabetes, smoking, sedentary lifestyle and psychosocial stress.

Patients with chronic stress, Dr Hafeez said, have an imbalance of hormones, which leads to unstable sugar levels, disposition of fats, effects on the brain, which ultimately leads to cardiac arrests and brain strokes. “Sedentary lifestyle, with less sleep, less exercise adds to it,” he added.

The stress is taking the toll everywhere.  In absence of any substantive study, the concerned doctors don’t have figures to establish it. But the number of sudden deaths is increasing every day.

Dr Sareer Ahmad Lone, 33, a resident of Nowshera Srigufwara in Bijbehara, breathed his last on October 10.

Dr Sareer Ahmad Lone. Source: Internet

Married in April 2019, Dr Lone, the family said, was studying till late into the night for his post-graduation exams on October 9. Around midnight he stood up to go to the washroom but as soon as he reached there, he fell down. “He was dead there only,” one of his relatives said but still, he was taken to a nearby district hospital, from where he was referred to SKIMS where he was put on a ventilator. Next day doctors confirmed him dead, saying he had a brain stroke. 

The family insists Dr Lone had never had any health issue. He is now survived by his wife and mother.

In another instance, around 34 km away in Kokernag, Mohammad Yusuf Bhat, 40, a father of three kids, was having a routine day at his kidswear shop on November 14. Around 1 pm he came to his house for lunch and told his wife he is having minor pain in the chest, casually. “She requested him to visit the hospital but he denied saying the pain is not severe,” informed one of his cousins, also a doctor.

But as soon as he reached his shop again, one of his neighbouring shopkeepers called him. As he looked back, he fell down. His neighbours quickly shifted him to a nearby hospital, which was just 2.5 km away. But the doctors at SDH referred him to the district hospital in Anantnag where he was declared brought dead.

 “He had died on spot. The SDH doctors had referred him just to avoid any reaction from his attendants, ” Bhat’s cousin said,  “Bhat never had any health ailment, no blood pressure nor even normal headache. He was not even a smoker. We are clueless how could  he have had a heart stroke when not even his parents have any heart problems.”

Bhat’s have a joint family. He is survived by his parents, wife, three children, his younger brother and sister, who are married.  

To console themselves and give a better reason for his death, his family presumes that may be he might have been stressed. “For more than a decade he was working at a hotel in Srinagar. But as his children started growing, the eldest daughter in class 12th, son in class 10th and youngest daughter in class 5th, he decided he should stay around. He started a shop, a kid’s garment shop, in his vicinity in early 2019 after taking a small loan from JK Bank. But then August 2019 happened, due to which Kashmir was put under clampdown for more than three months. From March 2020, another shutdown was announced due to pandemic which too continued for many months,” said his cousin. 

Journalist Maqbool Sahil

The incidence of heart attacks at a young age has increased over the past twenty years. “On an average 10 severe heart attack cases are received every day at SKIMS’s cardiology department these days. Ten years back the incidence was far less,” Dr Nisar Ahmad Tramboo, who heads the SKIMS Cardiology department, said.

Dr Nisar Ahmad Tramboo

He, however, said that our race in Southeast Asia which includes Pakistan, India, Afghanistan, are genetically predisposed to heart attacks at a young age. “The most important contributing factor is our unhealthy lifestyle where we take excess amounts of salt and animal fat,” he said. “Besides,  we have more stress in our lives which has increased over the last few years.”

In Srinagar, Aayat, 19, first-year science student, was preparing to write her annual exams. Around 1 pm, her mother asked her to have lunch. “I was spreading the sheet for lunch and she came and directly went towards the refrigerator.  She wanted to have a sip of juice before lunch. As soon as she got a juice bottle and tried to close the door, she fell. I tried to keep her awake but she did not open her eyes,” said Aayat’s mother Shameema.

Alone at home, somehow Shameema managed to take her to the hospital quickly. But it was too late. Doctors there said she is dead already. “She never had any heart problem or any other health issue. I am still surprised how did it happen.” Shameema said. “Doctors told me even if Aayat would have been on a hospital bed, she could still not be saved. She had a sudden cardiac arrest.”

But Dr Nasir Shams, a cardiologist at JLNM hospital, believes the increased number of cardiac problems are because people don’t keep a watch on their blood pressure, blood sugar and cholesterol levels. “Other than these we see people addicted to alcohol and drugs like heroin, smoking, which also becomes the reason for sudden cardiac deaths,” he said.

As the winter has set in, the heart attacks have become frequent. Dr Shams suggested people should take extra care.

“It is not that only a few people have blocks in their heart. We all have. Whatever we eat that gets deposited in our arteries and veins. If these depositions get to 30, 40 per cent then it gets critical” Dr Shams said. “Whenever it snows, we go for snow shovelling or we clear the snow from our paths, which makes it deadly and can lead to sudden heart attacks. Cardiac arrests can lead to death if not resuscitated immediately.”

An Initiative

Though there is no specific number shared by the authorities Kashmir has its share in around 9000 deaths that happen in India due to cardiac arrests. Understanding the need for proper care to such patients, a few cardiologists started a WhatsApp group, Save Heart Initiative in 2016, so that they can help maximum patients who otherwise were lost in the “golden hour”. 

Save Heart Kashmir logo

The main aim, officials said was  “to reduce the delay in treatment and improve survival.”

After four years, this group is a team of around 1200 doctors forming five groups. “Every day we see at least 30 to 50 ECGs of patients who complain of chest pain. This increases in winters because no chest pain can be ignored. These are mostly from peripheral areas where having a cardiologist is not possible every time,” said Dr Shams.

This initiative has been supported by Directorate of Health Services Kashmir, SKIMS and SMHS.

The crisis starts at the time of occurrence. As at the peripheral level, there is still a dearth of proper facilities. There is a dearth of cardiologists as well. As per the officials, there is roughly 60 per cent of cases from Kashmir peripheries and among them, more than 80 per cent have delayed presentation due to delay in diagnosis and transportation.

“The response we had initially for Save Heart Initiative is not there now. The hospitals at the district level were doing better than the hospitals which have been converted to GMCs now. They keep such patients for 6 hours and then refer them but unfortunately, we lose those patients. We need to evolve our systems,” said one doctor at SHMS hospital.

The Caution

Suggesting the precautionary measures, doctors dealing with the ailment say there is need for a change. “People with risk factors need to get themselves evaluated regularly. Other than that genetic factor also plays an important role in cardiology,” said Dr Hafeez. 

Sharing the details, he said: “It has been found that patients with myocardial problems in Southeast Asia are four times more at risk than Europeans and six times more than Chinese. The only thing we should do is to make people aware, leave smoking, eat good fruits and vegetables, 30 minutes of moderate exercise for 5 days in a week, and take care of your risk factors,” he suggested.

ECG. Source: Internet

Due to Coronavirus lockdown, he said people were restricted to their homes, which added to their weight. This leads to insulin resistance and then the rest of the damage is done by the stress.

A lot of problems, Dr Hanif said is due to “rapid urbanisation”.

“Stress is making our young generation look older than their age. And also because of working at odd hours and unhealthy eating habits, they are putting themselves at risk,” he said. “There is a need to eat healthily and think better.”

He further said the best time is “consumed by social media, Television and other sedentary lifestyle habits and there is no time for hobbies and outdoor activities.”

This, he said, is taking a toll and could aggravate the crisis, if not taken seriously and acted upon.

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