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The patient,( )how serious his illness was,still refused an

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The patient,( )how serious his illness was,still refused an operation.
A.not realize \x05\x05B.not to realise \x05
C.not realising \x05\x05D.not being realized
选哪一个,为什么?
C 句子结构可以唤作如下
The patient still refused an operation,not realizing how serious his illness was.
首先排除A和D,这句话中不缺乏谓语(refused),所以不能用A ;意识是个人所拥有的主动形式,没有必要用被动,排除D
然后是句子结构,not realizing how serious his illness was作主语(He)的修饰状语从句,这里是从句结构,不能用不定式,排除B