Paper Doesn't Refuse Ink, as my Dad says

Warning: this post does not have an inverted pyramid structure. The middle matters. Lots.

There's an interesting and important article by Kitty Holland in today's Observer about the tragic story of Savita Hallapanavar's death, with the most important sentence in the piece being buried in the middle of it all:

"Whether the fact that Savita had been refused a termination was a factor in her death has yet to be established."

Why is this the most important sentence? Because that's the sentence that pulls the rug out from under the whole piece. Savita's death has been reported worldwide, with Kitty Holland being the reporter who broke the story, and in explaining the story in the Observer, Holland makes it clear that from her point of view this story was always about abortion.

Holland says that her contact in the West told her of a woman who'd died after repeatedly requesting a termination. She realised that this could be a story with enormous political and constitutional ramifications, as abortion is the most divisive issue in Ireland and, she believed, the death of a woman in these circumstances was probably inevitable given the lack of clarity in law. Holland tracked down and rang Savita's husband, Praveen, who told her the story...

It was published, and went global. There was a spontaneous protest outside the Oireachtas, with up to 2,000 people there, or so Holland says, though the Gardaí put the numbers at about 700, and RTE and Channel 4 had reported that the vigil was to be numbered in the hundreds. International attention increased, with Savita's parents being quoted as having accused Ireland of murdering their daughter.

"The pressure," she concludes, "for something to be done about the legal morass around abortion is greater than it has ever been – not only domestically but this time, it seems, from across the world. Praveen Halappanavar, a quiet-spoken, gentle young man who was so determined to tell me what happened to his young wife, may yet prove the loudest voice those seeking change here have ever had."

True. And yet as she admits in a single sentence buried in the middle of the column, this story may have nothing whatsoever to do with abortion.

'Never Again,' say the posters, 'Abortion rights now,' though a termination might not have saved Savita

Lessons in Journalism

The fact that it's buried in the middle is significant. Newspaper stories tend to be structured on the principle of an 'inverted pyramid', with the big stuff at the start and then stuff being decreasingly salient; a 'kicker' is frequently deployed at the end, to hammer home what the journalist sees as the key point.

People often read columns that way, after all. They look at the headline, read the first couple of paragraphs, skim down, and look at the last paragraph. I'm not sure if people read them that way because we realise they're written that way, or if they're written that way because we read them that way. I reckon it's a circular phenomenon, which is also handy for editors as it gives a general thumb on what to cut out for reasons of length.

Look at that piece again. The headline says that Savita Hallapanavar's death may stir Ireland to change over abortion. The first paragraph says that when Holland learned a woman had died after asking for a termination, she realised this could be a big story with massive political and constitutional ramifications. The second paragraph is all about abortion, and specifically says that the death of a woman in circumstances such as Savita's was probably inevitable given Ireland's laws. Then there are eleven paragraphs telling the story, before a final paragraph about abortion again.

And buried in the middle of the piece, in the eighth paragraph of fourteen, is the admission that the story may have nothing whatsoever to do with abortion.

How Little We Know...

Investigations have yet to take place into why Savita died. Not in the most straightforward sense, as we know she contracted E.Coli and septicaemia. Rather in the sense of when and how she contracted the infection that killed her, whether she was given the best healthcare possible, why exactly her request the pregnancy be ended was rejected, whether a termination would have saved her life or whether it might even have further endangered her.

We don't know any of this. Her medical charts are not in the public domain. These things are all about details and specifics, and those details and specifics have not been published. All we have to go on are the heartbroken words of a man who recently watched his wife die.

In the absence of the medical data, anybody -- even an obstetrician or gynaecologist, no matter how well qualified -- who insists that a termination would have saved Savita's life, or that it would definitely have endangered her further, is talking nonsense. Assertions in this matter are mere speculation, and conjecture, as a sensible pro-choice friend said to me yesterday, doesn't help.

We don't know if Savita died because she was denied the option of having a miscarrying pregnancy terminated. The head of Dublin's Rotunda Maternity Hospital says this case probably wasn't about abortion laws, and was almost certainly about how a clinical situation involving miscarriage-related infection was managed; whether different management of the situation might have saved Savita's life, he says, is something nobody can say. If we're honest we should admit that we know next to nothing about this. All we really have are questions.

A Couple of Questions

Not, of course, that you'd think that, to see the hysteria that the Irish media has kicked up, presenting the story as a straightforward tale of a woman who died because she was denied an abortion, with this decision being due to a lack of clarity in Irish law.

We just don't have the facts to say that. Just as an example of how little we know about this, and if you're familiar with the facts of the case as reported, ask yourself the following question: on what day did the hospital start Savita on antibiotics?

Tuesday? Well, that's certainly what Holland and Paul Cullen, the Irish Times' health correspondent, reported in Wednesday's Irish Times, in the most-read story in the newspaper's online history. Savita's husband Praveen is specifically identified as the source for this detail, with him placing it in the exact context of Savita shaking, shivering, vomiting, and collapsing; it was in response to this, he said, that "there were big alarms and a doctor took bloods and started her on antibiotics".

This is what prompted the Guardian's Health Correspondent, Denis Campbell, to end his piece on the coming investigations into what happened in Galway by saying:

"Savita appeared to be in trouble as early as Sunday. The apparent failure to recognise that risk then, and to start her on antibiotics until the Tuesday night, will be the most urgent question for those investigating."

Curious, isn't it, that the Guardian's health correspondent, looking at the facts of the case at least as initially presented, thought the most urgent question was not whether a preterm delivery would have saved Savita's life, but why the hospital didn't start Savita on antibiotics until two days after she would appear to have been in danger?

To his mind this seemed less like an abortion story than one about a failure to anticipate possible infection. But of course, he was entirely dependent on the facts as originally reported by the Irish Times, quoting an interview with Praveen that took place several days before the story was published on 14 November.

RTE, strangely enough, seems to suggest that this isn't what happened. The national broadcaster's website  states that it had obtained details of the timeline of events as viewed by Galway University Hospital, with the hospital saying that on Monday 22 October, "After 24 hours of admission, antibiotics are given."

So it would appear that on this, at least, Praveen and the hospital disagree. Except that Praveen was interviewed by Kitty Holland a second time, this second interview being posted on the Irish Times' website for people to listen to. You should definitely do so, at least if you're genuinely interested in what happened in this horrible situation. About four minutes into this interview, Praveen clearly and explicitly states that the hospital put Savita on antibiotics on Sunday. He said that on Sunday Savita was told that it looked like the baby wouldn't survive and that it would be all over in four or five hours; she was put on a drip, he says, and the hospital started her on antibiotics.

Which was it? Tuesday, as Praveen originally said? Sunday, as he now says? Or Monday, as the hospital apparently says?

If you're still inclined to make assertions about this, try this: when did Savita's baby die?

Well, the initial Irish Times report stated that at lunchtime on Wednesday -- more specifically around two o'clock according to the interview which we can listen to --  the foetal heartbeat stopped, and Savita was taken to theatre to have contents of her womb removed.

But RTE reports that, according to the hospital, she was transferred to theatre on Tuesday, with spontaneous miscarriage happening there. Or at least, so I read the terse statement "Patient transferred to theatre. Spontaneous miscarriage occurs." The hospital account seems to suggest that this happened late on Tuesday night, as it says Savita was taken from theatre to the Intensive Care Unit on Wednesday.

Or was she? Because that's not what Praveen says. He says, on the recording, that Savita was taken to the High Dependency Unit and Praveen went there with her. He says he went home at about ten at night to freshen up, and between half eleven and twelve he got a call from the hospital and rushed there as she had been transferred to the Intensive Care Unit.

Not Just Difference of Interpretation; Differences of Fact

We probably shouldn't be surprised that the hospital's version of events, even in this bald form, is substantially different from what the Irish Times has published. Remember James Reilly's admonition not to prejudge things, and his caution that he was privy to facts that he wasn't privileged to share? Look at the problems that even a cursory comparison of the two timelines present us with:

• The Irish Times quotes Praveen as saying that the hospital started Savita on antibiotics on Tuesday and features a recording of a later interview with him saying it did so on Sunday; RTE reports the hospital as saying that she was started on them on Monday.
• The Irish Times reports Praveen as saying that the baby died at lunchtime on Wednesday, but RTE says the hospital has it that spontaneous miscarriage occurred in theatre on Tuesday.
• Praveen says that Savita was taken from theatre to the High Dependency Unit on Wednesday as the hospital said she should spend a few hours there, that he followed her there, and that approaching midnight he got a call which caused him to hurry to hospital as Savita had been taken to the Intensive Care Unit; RTE says that the hospital says Savita was taken from theatre to the ICU on Wednesday, apparently without going to the HDU.
• I'm not even sure if the accounts of what happened on the original Sunday match up. In the recording Praveen describes himself being told by the doctor "It looks as though the baby's not going to survive," confirming that he was sure of this. The original Irish Times report described this by saying that Savita "was found to be miscarrying", which to an utter layman like me sounds absolutely certain. But according to RTE, the hospital say that Savita was taken to the Obstetrics and Gynaecology Unit with "a threatened miscarriage". Now, I'm obviously no expert, but this sounds like something like a situation where the baby* could perhaps be saved.

Still, even without getting into what happened on the original Sunday, it still seems clear that the two accounts are utterly impossible to reconcile. Either Praveen is wrong, or the hospital is wrong, or RTE's source isn't in fact the hospital and is making things up. I have no idea of telling which is which, and right now I think there are very few people who do. 

If RTE's source is indeed the hospital -- if this is indeed the timeline of events as viewed by the hospital -- then we have to think about what this would mean. Even with poor documentation, the hospital should have clear records of what day Savita was taken to theatre, and whether she was taken straight from theatre to the ICU or whether she first spent a few hours in the HDU, and there should be very clear records of when antibiotics were started.

If the hospital's paper trail matches the timeline as given by RTE, then this surely means that either the hospital's story is substantially correct and Praveen's is wrong, for whatever reason, or else that there has been a massive effort made in the hospital to cover up something very dodgy. If it's the latter, we'd be dealing with massive malpractice, and a huge cover-up.

And no, I'm not suggesting that for an instant. But that's what this would mean, if it were the case.

Right now we just don't know, which is why we have to wait for the hospital's own investigation and the HSE's investigation to be complete. Faced with a story as shocking as this, people have serious grounds for worry, and even for anger, but we don't know what we should be worried or angry about.

As Kitty Holland says, in the middle of today's column, it has not yet been established whether Savita's death could have been avoided had her reported request for a termination been granted.

Note to the Irish Fourth Estate: the Spectator sees more of the Game

Certainly, one thing I'm worried about is the quality of journalism in Ireland at the moment.

How has the Irish Times ran two conflicting versions -- one written, one aural -- of the same story, and not noticed that they contradict each other? Did Kitty Holland not spot, the second time she interviewed Praveen, that his story had changed in at least one small but vitally important respect?

How has nobody picked up on the fact that the sequence of events as described by the Irish Times, with Praveen as a source, and RTE, dependent on the hospital's viewpoint, are completely at odds with each other?

Why is the Irish Times coverage of this against the backdrop of how things are so much better in Britain, glossing over how many women die in Britain every year from pregnancy-related sepsis, and with Britain's law spectacularly** misrepresented?

Why hasn't the Irish Times reported on the apparent fact that pro-choice groups in Ireland were given wind of a 'denial of abortion' story several days before the Irish Times ran Kitty Holland's and associated pieces?  Just judging by what I noticed on Twitter on Tuesday night it seemed to me that last Wednesday's vigil, for instance, was as about as spontaneous and organic as such things can be, but it also seems clear that certain people who advocate abortion pretty much on demand -- clarification on 'X' looking like little more a a wedge for them -- were well positioned that day to shape the story of Savita's death as a 'denial of abortion' one, when it may have been nothing of the sort, and to whip up popular rage on this issue. At the very least, surely any responsible paper should be asking whether cynical opportunism is at work...

And why on earth is it that nobody's screaming about how the Irish Times is reporting that the Gardaí say 10-12,000 people took part in today's march through Dublin in remembrance of Savita, demanding that Irish abortion law needs to be changed so nobody else need ever die as she did -- even though, as noted, no link between the two has yet been established -- while RTE is saying that Garda figure is merely that more than 6,000 people marched?

Other parts of the march, to be fair, looked more dense than this.

Though I'd not rule out the larger figure, I find the smaller one a bit more plausible, given that this march took up six or at most seven times as much space on the ground as the 'March for Choice' one in early October that had just 850 people in. Thereabouts, anyway. You remember, the one where Garda estimates, as reported in the Irish Times, were dramatically and mysteriously raised from about 800 to more than 2000. 'Several thousand', as the Irish Times eventually put it. But still, surely the thing to wonder is why the Gardaí are supposedly giving out different figures for this.

This stuff is serious. We need to be honest here, and refrain from manipulating numbers because we don't like how they don't suit us, holding off until the facts are in before jumping on stories that suit our agendas.

It may well be that pro-lifers are going to find that they have blood on their hands over this, but we just don't know. As things stand, it's almost as though Irish journalists have en masse decided to abandon all pretence of objectivity, and have taken sides, like cheerleaders with typewriters, the very thing that former Irish Times sports writer Tom Humphries rightly said journalists should never be.

There are investigations going on. We need to wait.

______________________________________________________________________
* I've noticed no shortage of people out there sneering at pro-lifers describing Savita's daughter as a baby, rather than a foetus. You can see a good example of that quoted over on this midwife's blogpost on the matter. Here's the thing: it's clear that Praveen and Savita called their unborn child a baby. Listen to the long interview with Praveen on the the Irish Times website. He repeatedly refers to his daughter as a baby.

** The other day, for instance, there was a piece entitled 'What would have happened in Britain?', which cited two of Britain's leading abortion providers as sources and wrongly claimed that British doctors "are legally able to carry out abortions until the 24th week of a pregnancy for all reasons, not just medical". This is a commonly-held and utterly false trope in Ireland; abortion is fundamentally illegal in Britain even now, under the terms of the 1861 Offences Against the Person Act or the 1929 Infant Life (Preservation) Act.

Rather than legalising abortion, the 1967 Abortion Act conferred certain defences against illegality upon doctors who carry out terminations, provided the terminations cab be justified under at least one of five grounds. Two of these grounds, being injury greater than that caused by termination to the health of the woman or her existing children, are subject to a 24-week gestational limit. British doctors are most definitely not allowed to carry out pregnancies up to that point "for all reasons", which is why there was a huge ruckus earlier this year when it was discovered that British clinics were aborting babies because their parents didn't want to have baby girls.

And the Irish Times know this: it specifically reported on this issue back in February.