Back from the brink


He went into a coma after six cardiac arrests and he had his stomach removed.

Doctors at the National University Hospital (NUH) gave Mr Supramaniam Rajandran little chance of survival.

But he overcame the odds to recover after more than a year of suffering and recently bagged a diploma in aerospace avionics from Republic Polytechnic.

"I never look back, so I do not feel for what has passed," said the 30-year-old, who is fondly called Mani by his family members and close friends. "I have dreams of becoming financially independent, so I am thinking about ways to achieve that."

Mr Supramaniam's ordeal began on May 26, 2016 when he suffered a cardiac arrest at night while alone at home.

He managed to call for an ambulance but collapsed soon after.

When his parents and sister reached home, they found him lying motionless on the floor.

Ambulance paramedics soon arrived and tried to resuscitate him.

He was rushed to the NUH's emergency department and placed in the intensive care unit, where he suffered five more cardiac arrests.

"A doctor told us that had he arrived even five minutes later, he would have likely died," said his sister Kavitha Rajandran, 24.

The medical team at NUH quickly established that Mr Supramaniam had suffered a blood clot (deep vein thrombosis) in his leg which had resulted in pulmonary embolism (sudden blockage of a major blood vessel) and multiple cardiac arrests.

"But the doctors were not able to clearly identify why Mani, who weighed 120 kilograms, suddenly suffered this," said Ms Kavitha.

After a CT (computed tomography) scan, the doctors immediately proceeded to perform a high-risk surgery to provide Mr Supramaniam with extra corporeal membrane oxygenation (ECMO).

The ECMO provides prolonged cardiac and respiratory support to people whose heart and lungs are unable to provide adequate gas exchange or perfusion to sustain life.

"The doctors told us that if Mani's heart does not beat in five days, we may need to brace ourselves for his death," said Ms Kavitha.

Mr Supramaniam was supported with ECMO under a medically induced coma. Eventually, he recovered sufficiently for the ECMO to be discontinued.

Doctors, however, said he still had other complications. Mr Supramaniam had to remain in the ICU for three months. During that time, the stress his body underwent from the pulmonary embolism and multiple cardiac arrests resulted in ulcers forming in the walls of his stomach. These caused severe bleeding. The doctors had to perform gastrectomy, a procedure to remove his stomach.

Mr Supramaniam said his parents, who declined to be interviewed, did not tell him about the stomach removal till a year later.

"I was also going through regular kidney dialysis. They did not want me to suffer further," he said.

After almost five months at NUH, Mr Supramaniam underwent further treatment for more than a month at St Luke's Hospital. He remained mostly in bed during that period.

The medication caused mental ailments such as hallucination and depression which necessitated psychiatric treatment. It was an ordeal that would have knocked out any young man.

But Mr Supramaniam managed to fight on. He was finally discharged from St Luke's Hospital on Dec 9.

"Mr Suparamaniam had a difficult and a very prolonged hospital stay complicated by multiple problems," said Dr Jimmy Hon, a senior consultant at the Department of Cardiac, Thoracic and Vascular Surgery at the National University Heart Centre, Singapore. "He eventually overcame the odds and survived this near-death situation."

Mr Supramaniam returned to Republic Polytechnic in April 2018 to complete his tertiary education, which he had started at the age of 24 after working for several years at his uncle's food stall.

In May this year he got his diploma. He is now working as a Grab driver as he waits for the Covid-19 pandemic to abate so that he can look for better job opportunities.

Mr Supramaniam said life is almost back to normal, except that he has to be careful while taking his meals. He needs to rest for around half an hour after eating. To maintain the continuity of his gastrointestinal tract, for digestion and absorption of food, his small intestine was interposed (the oesophagus was connected to the small intestine).

"The absence of a stomach is still compatible with life and patients eat much less but frequent meals," explained Dr Asim Shabbir, a senior consultant at NUH's Division of General Surgery (Upper Gastrointestinal Surgery) who regularly treats Mr Supramaniam.

"To prevent deficiency in nutrients, such as protein, iron, vitamin B12 and calcium, he needs lifelong supplementation and monitoring."

Dr Asim clarified there are many patients who live without a stomach.

"Some nutritional issues do arise as a result of a lack of a stomach and these include deficiency of iron, vitamin B12 and calcium for which supplements are prescribed," he said.

"Bulk eating is no longer possible and the digestion of proteins is impeded due to the lack of stomach acid."

Mr Supramaniam said he eats out with friends as usual. "Of course, I still eat spicy food, I am after all an Indian," he said with a laugh.

He also consumes a limited amount of wine and liquor. Seeing him back on his feet has made his parents happy. But they too suffered a lot during his hospitalisation.

"My mother and father were depressed," said Ms Kavitha. "My father suffered a heart attack while Mani was in the ICU, and so my mother and I had to visit them in different ICUs."

Mr Supramaniam's father Rajandran Alagan, 56, used to work as a lorry driver and security guard. After a neck surgery in 2011, he has not been working.

The family has to depend on the earnings of the mother, Madam M. Susila, 54, a civil servant.

"Often, when I feel gloomy, my father motivates me and tells me to look ahead," said Mr Supramaniam.

The encouragement from the family helped the former dragon-boater and gym enthusiast to complete his diploma at Republic Polytechnic.

As he missed school work for nearly a year, he had to repeat several courses. He also had to do physical work during his internship at Singapore Aero Engine Services.

"I had some good friends and my fiancee Jeyanthi by my side," he said.

"Whenever I felt like giving up my studies, they motivated me to push on."

He is now happy that he is leading a near-normal life. "Other than needing to be cautious to some extent, I hardly think of my medical condition as an issue now," he said.

"I never look back, so I do not feel for what has passed.

I have dreams of becoming financially independent, so

I am thinking about ways to achieve that."

- Mr Supramaniam Rajandran

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