A uniformed royal ADC rushed out and whisked neurosurgeon Dr Upendra Devkota from his clinic. "The Crown Prince has bullet injuries, we are going to Chhauni," he told a dazed Dr Devkota. Cars, motorcylces and people struggled to get out of the way as the jeep, speeding sometimes at 80 km/h, made the journey from Thapathali to Chhauni in less than four minutes.
Following are excerpts from an exclusive Nepali Times interview with Dr Devkota about the unimaginable sight that greeted him at the trauma hall of the army hospital that Friday night, and his recollection of the events of the next three days:
The way the army chap was driving, I knew something was very wrong with the Crown Prince. At the hospital, there were military personnel swarming at the gate, people were running around. It is obvious in retrospect that those who brought me wanted me to go upstairs to the Crown Prince first, but others already there dragged me to the main hall for trauma victims. So some were saying this way doctor, others were saying upstairs doctor. All I knew till then was that the Crown Prince had bullet injuries. I was shown into the hall and taken to the first patient on the left. He was extremely pale, blood-splattered beige kamij and suruwal, grey hair, a Sai Baba locket around his neck, he was being ambulated. I didn't know who this patient was, but I knew from a distance that he was lifeless. I looked at his eyes, felt his pulse, and said he's gone.
Dr Khagendra Shrestha then arrived and took me diagonally to the other side of the hall, murmuring: "Disaster, everybody has been massacred." There was a body covered with a sheet. He lifted the sheet and said, "This is Her Majesty the Queen." The whole upper part of her head had been blown off. Before I could react, he took me to the next stretcher on the floor, and lifted the sheet, and said: "This is His Royal Highness Prince Nirajan, gone already. This is Princess Sarada."
By this time, I'd seen enough. He took me to the next stretcher where a patient was still being resuscitated and he said, "Princess Sruti". At last I saw someone still alive. But she was in poor shape, her heart was barely beating, pulse was not palpable, after a quick look there were no obvious external injuries, so at first glance it could have been internal bleeding or a nemothorax. But there were doctors looking after her and there was no head injury, so Dr Shrestha rushed me off back to the same first very pale patient with the Sai Baba locket I had seen while coming in, and he said: "This is His Majesty."
That was when it became very emotional for me. The shock finally hit me: all the royal family was gone. Till then, no one had told me what had happened, but I knew these were bullet injuries and it began to sink in that whoever did this was trying to wipe out the whole royal family. Possibilities began racing through my mind: could it be the military, the Maoists? But I didn't ask anyone. I paid my last respects to the king and walked out. I had flashes of memory of having met him during a big international neurosurgical conference in Kathmandu three years ago: he was a perfect gentleman, and he felt deeply for the country. It was difficult to accept that he was gone, it was as big a loss for me as when I lost my father and mother.
Then I was rushed upstairs, and I couldn't think about that anymore. The army medical personnel had prioritised the patients according to their condition. I changed into surgical greens, and entered the operation theatre, passing four more injured patients whom I didn't recognise then. The crown prince was there with two wounds on either side of his head, some blood and brain tissue oozing out. There were no other wounds in his body, and they had taken everything out except his underwear. They had already put a tube down his throat, an IV line, it had all been done very professionally. The blood pressure and heart rate were on the monitor, reasonably okay at 110/70 or 80. He had dilated and fixed pupils, but he was twisting his arms and legs, which meant he was not brain dead. He was trying to breathe, they were assisting his breathing with bagging. So in my assessment at that time he had a Glasgow Coma Score of 4, not 3 which is the lowest. The outlook was extremely poor. We had to attempt the best possible care, and give a chance for a miracle to happen.
There were extremely competent colleagues attending to the crown prince, and we proceeded to paralyse him, put him on a mechanical ventilator and arrange four units of blood for the surgery. We had the army neurosurgeon, Dr Sharma, we called the Bir Hospital plastic surgeon Dr Joshi and fortunately we had theatre assistants who had worked with me before at Everest Nursing Home. That was very convenient, because they were familiar with my technique which is important. But before the surgery, I looked at the other injured to see if there were any other neurosurgical casualties. Dhirendra was very breathless, but conscious, Princess Komal was in the corner with a chest wound, the bullet having just spared her heart, Kumar Gorakh was there, Ketaki Chester had a shoulder wound but she was able to talk.
The entry wound on the crown prince was just behind the ear on the left side about 1 cm wide, a bigger exit wound on the right side above the ear. There was a decision to be made: should I take him to the neurosurgery ICU at Bir which has better equipment and trained staff. I realised that the transfer itself would jeopardise what little chance of survival he had. We did a brain x-ray to rule out metal fragments so that we could do an MRI later-to do an MRI with metal inside would have been inexcusable. There was no metal. We enlarged the wound on the left side, removed dead brain tissue, stitched it, turned the patient around and carried out the standard procedure, cauterising, removing bone fragments, leaving an opening in the covering of the brain in case of future infection. Then Dr Joshi provided the skin cover.
Finally, I had time to go to the surgeons' room. I had a chat with some colleagues and at last I heard: the person I had just performed surgery on, the crown prince, had killed everyone. Personally, for me there was a sense of relief. Of course, it was a terrible tragedy for the royal family, but the other alternatives (that it was an outside job) were more sinister for the country. I had lost track of time, it was now getting light outside. We did the MRI, the bullet had gone through both thalami causing intraventricular bleeding. These were all bad signs. The treatment plan was standard: take him to the ICU, continue antibiotics, continue ventilation to reduce intracranial pressure, elevate the head to 30 degrees. Dr Shrestha said okay, we can disperse and meet at ten in the morning, but Prince Gyanendra was supposed to arrive any moment so we waited. The feeling in the army hospital was: well, at least somebody from the royal family is alive and there is someone to take charge of the situation.
The prince arrived, he took a quick look at all the casualties, he went up to the library and called Dr Shrestha and me. The prince looked at me and asked: "Tell me, how is the crown prince." I described the situation without any ambiguity: any through-and-through injury of the brain behind the hairline is usually fatal. I said that although he is still alive, the long-term prognosis is very, very poor. The prince looked very grave, but kept his composure. He looked like he was under control, he was decisive and did not waste time. In retrospect, I realised that they had a very serious problem communicating to the public, letting the media know. But I have to say that they never interfered with the medical side of things.
We planned to meet at 1000 and dispersed. I had just gone home and taken a shower when the hospital called again and said I had to come down to reassess the situation by nine o'clock. I called and stopped all sedation and the drugs for paralysis, and by the time I got there at nine the patient was marginally better, he was trying to move his legs, breathe and cough. He was alive, the same as yesterday if not better, and we had to continue aggressively treating him. This was conveyed up the line, and I think the procedures got underway to declare him king, declare King Birendra dead and Gyanendra Regent.
Sunday was a very stressful day, we had to attend to Prince Dhirendra and we hadn't eaten anything all day. By Sunday evening King Dipendra was moving rapidly into brain dead criteria, we had a medical board meeting, we met Prince Gyanendra, told him that the chances of surviving were zero and explained the options: with the family's full consent you could turn off the ventilator, or you could follow cultural norms and let nature take its course and consider the patient dead only after the heart stops beating. Prince Gyanendra listened to this, and said: "Let me discuss this with the Queen Mother." He came back soon after and told me: "Ok, doctor, let nature take its course. Keep on treating him." He also told us to do everything possible for Bhai (Dhirendra). Early Monday morning, King Dipendra's heart stopped, there was an effort to resuscitate him, but he did not make it. He came into our care as crown prince, and
died as king.
Now, if you ask me if there was a conspiracy. I should say, not directly. But there is a conspiracy in this country to turn our youth into drug addicts. Even the royal family is not safe. This is a conspiracy by the mafia and the traffickers.
(Dr Upendra Devkota is Chief of Neurosurgery at Bir Hospital and was trained at the Institute for Neurological Sciences in Glasgow and the Atkinson Morley's Hospital in London.)