A determined Nirbhaya is hanging on by a slender thread. At 9pm (Singapore time) on Friday, Mount Elizabeth hospital issued a grim update on her health – that her condition has taken a turn for the worse, she has had "severe organ failure" despite maximum artificial ventilation support and optimal antibiotic doses. Her family was informed at 6.30pm IST about her deteriorating condition and was currently by her side "to encourage and comfort her."

This is the grimmest fight that Nirbhaya is putting up in the last 12 days since she was brutally gang–raped on December 16. Earlier in the day, the Singapore doctors admitted that Wednesday’s cardiac arrest had caused severe damage to Nirbhaya’s brain. It is learnt that fluids had begun to accumulate in her lungs which could not be drained out because her blood platelet count dipped to almost 60,000.

Doctors in India following the case told TOI "she is being infused with fresh frozen plasma. As soon as her blood platelet count improves, the fluid would be drained out." Investigations carried out by the multi–disciplinary team of specialists in Singapore showed that in addition to her cardiac arrest, she also had infection of her lungs and abdomen, as well as significant brain injury. "The patient is currently struggling against the odds, and fighting for her life," the hospital said in the morning.

Speaking to TOI from Singapore, cardiologist from Mount Elizabeth hospital Dr V P Nair said the cardiac arrest Nirbhaya suffered could have damaged her brain significantly. "If blood supply to the brain stops for two–four minutes, the brain can take a real hit. On Wednesday, Nirbhaya had suffered a cardiac arrest and for three minutes doctors could not find her pulse or blood pressure. That episode may have seriously injured her brain." Dr Nair warned that another episode of cardiac arrest could push her into irreversible brain death and coma.

Nirbhaya’s abdominal condition is possibly the main reason for all the subsequent complications, including high infection, cardiac arrest and now the multi–organ failure. Prior to her being flown to Singapore on Wednesday night, she had already undergone three abdominal surgeries in which her small intestine was removed, but even this hasn’t contained the infections.

Doctors from Safdarjung hospital and AIIMS who were looking after Nirbhaya before she left for Singapore told TOI that Dr David Grant – the world’s leading bowel transplant surgeon in Toronto ––was consulted to see if Nirbhaya could be saved with a bowel transplant.

Just three inches of the six–meter long small intestine remained in the body of the 23–year–old physiotherapist. This meant that even if the girl pulls through, she would not be able to have solid food for years. The small intestine is actually one of the most vital parts of the human anatomy and is where 90% of the digestion and food absorption occurs.

Enzymes and bile acids break down food with all the nutrients absorbed by the inner walls of the small intestine into the blood stream. With no small intestine left, her body will have to receive nutrition directly into her vein called Total Parenteral Nutrition (TPN). She won’t be able to have food through the oral route for years.

Dr Grant, who is a professor of surgery at the University of Toronto and has published more than 200 papers on transplants and has recently reviewed results of 2000 bowel transplants conducted around the world till now, told the Indian team that she was not fit for such a transplant, dashing all hopes. Singapore’s Mount Elizabeth hospital has no experience of conducting such a transplant.

"Dr Grant who performed the first liver–small bowel transplant in 1989 and is the current president of the International Intestine Transplant Society informed us that she has to be on TPN for two years to be eligible for a transplant," a doctor told TOI.

Dr M C Misra from AIIMS said, "Bowel transplant is done in very few numbers even in developed countries. Also, its success rate is very low. If kidney and liver transplant has a 90% success rate, it is as low as 30%–40% in case of a bowel transplant."

11am | The patient continues to remain in an extremely critical condition. Our medical team’s investigations showed that in addition to her prior cardiac arrest, she also had infection of her lungs and abdomen, as well as significant brain injury. The patient is currently struggling against the odds, and fighting for her life

9pm | The patient’s condition has taken a turn for the worse. Her vital signs are deteriorating with signs of severe organ failure. This is despite doctors fighting for her life including putting her on maximum artificial ventilation support, optimal antibiotic doses as well as stimulants which maximi e her body’s capability to fight infections. Her family members have been informed that her condition has deteriorated and they are currently by her side to encourage and comfort her TIMES VIEW

The deterioration in Nirbhaya’s condition will heighten our anguish and intensify our anger against the crime. This makes it all the more important for all of us to focus now on the real reason behind Nirbhaya’s agony — the lack of respect for women in our patriarchal society. Instead of venting our anger in mindless violence, let us seize the moment to make a collective pledge to treat all women with respect and to demand the same from others. Let us swear that we will fight discrimination against them at home and the workplace. Let us resolve to intervene when we see a woman being harassed by word or deed and to ensure that complaints are lodged and acted upon. It will be a long and demanding fight within ourselves and with the world outside, but it will be one that genuinely honours the Fearless One