'Inside COVID-19 ward, PPE was an equaliser, made me realise some are just luckier than others'
Whenever I would go to the COVID-19 ward, I had to tell everyone that I was the consultant to get their attention; this taught me that ultimately every human on this earth is equal
It was New Year’s Eve, and I was at home after almost four years. I had been working non-stop, first as a medical intern and then as a resident doctor. 2020 was going to be my year off – I had planned to spend time at home, study for the entrance exams, and visit my fiancée in London. For many people, New Year’s Eve has been about that — making resolutions, travel plans, and anticipating what the next year will have in store. But who could have predicted that within three months, 2020 would indeed become a ‘year off’ for the entire world!
The first two months went by as people started taking cognisance of the novel coronavirus which was raising its ugly head in some parts of the world. Until then, news channels had just started to report the outbreak in China as ‘other news’. Definitely not the headlines. Then came the routine WhatsApp forwards, memes and jokes about Go Corona Go. People also joked that The Simpsons had already predicted the outbreak, as had the movie Contagion. But, later as the disease progressed, the jokes and memes about the end of the world came worryingly close to home. The mood had changed to panic. Finishing touches were added by the World Health Organisation when it finally declared, in early March, that the world was facing a new flu pandemic. Suddenly, the coronavirus was everywhere: not only in terms of its rapid transmission rate, but also infected our vocabulary. People learnt new terms such as ‘social distancing’ and ‘quarantine’, along with the slogan of ‘stay home, stay safe’. Educational institutes and offices started shutting down. Borders were sealed. Airports were empty. Travel came to a standstill.
As a doctor practising in a small city in India, I personally had many thoughts in my mind. Firstly, whether a nation like India, which is one of the most populous countries in the world, would be able to sustain this kind of crisis. With our extremely dense cities and poor living conditions, it would be extremely difficult to control the spread of the virus in the country.
Secondly, would our healthcare system be able to tackle this crisis? As we all know, India is a nation of disparity. Even when it comes to healthcare, which is supposed to be a universal right, only those with money are able to access it easily.
But as the days progressed, it became clear that the coronavirus did not discriminate on the basis of class/gender/caste/religion/age or any other parameter. It had already started spreading like wildfire in the country.
As expected, since the number of cases in India had started rising alarmingly, the Government of India imposed a nationwide lockdown to curb the community spread of the virus. The news became flooded with coronavirus updates in India and around the world. The first pictures of healthcare workers in hazmat suits went viral. They showed doctors, nurses, and other healthcare staff working non-stop for the care of patients. Being a doctor myself, and that too a recent MD in the most core clinical subject (Internal Medicine), this was when I really started to think about this whole situation and my role in it.
I wanted to be on the frontlines despite the risks associated with it. Seeing my own colleagues, friends, and members of the fraternity battling one of the most severe pandemics of the modern world, I could not just stand by and watch. As luck would have it, I got a call from the district civil hospital to be on duty as the locum physician in-charge of the COVID-19 ward, as a respite to the current physician who had been working there for 60 days continuously.
When I first got the call, I didn’t know how to react. On the one hand I was happy that I got this opportunity, but on the other hand, like any other human being, I felt apprehensive as well. There were many questions inside my head, such as would I be able to manage all patients properly? Could I be able to handle serious cases? How would I adjust to the new environment and staff? How would I tolerate wearing the PPE and hazmat suits in this scorching heat? And most importantly, would I be safe? I did not have much time to process these questions, as I was to start my posting just a day after I got the letter of appointment. But I was determined to give my best in this situation.
My near and dear ones were obviously worried, especially my mother. She herself is a doctor, but a mother always puts her child’s safety first. Doing COVID-19 duty meant that I would have to remain in quarantine too, and won't be able to get in close contact with anyone, especially my parents and grandparents. Thus, I shifted my stuff to the top floor bedroom in my house which is on the terrace and separated from the rest of the house and made it my new humble abode.
It was the perfect place to maintain distance from my family and still get home-cooked food! This also meant that I had to wash my own clothes. I got to experience how untouchability must have functioned in the old days, and realised, sadly that it is still prevalent in many parts of India.
On the first day of duty, I was told to take rounds with the outgoing physician so that I would get oriented with the space and also learn my responsibilities. I was going to take his place for the next week. Once I got out of my car and met him, we started walking and he told me that the structure in front of us was the ‘corona ward’. It was once the swine flu ward of the hospital.
Suddenly, the speed at which I was walking reduced drastically. Maybe it was a reflex action to the fear in my mind. The human mind is a complex structure indeed. It functions with the help of stimulatory and inhibitory neurotransmitters. Maybe at that moment, the inhibitory neurotransmitters were released into my nervous system. Seeing my pace slow down so suddenly, the physician chuckled, assuring me that it was going to be fine as he had been doing this for almost two months.
We finally reached the ward and started to wear the personal protective equipment (PPE) which included a suit with a hood, shoe covers, an N-95 mask, gloves and a goggle for eye protection. I took my time in getting inside the protective gear as I double checked each and everything I wore. Other than this, I wore another pair of gloves and ultimately a face shield. Looking at the small mirror, I couldn’t recognise myself! I looked like I was an astronaut in some other world, fighting an invisible alien object. I guess this is somewhat true!
We finally stepped into the ward. It was actually an open courtyard in the middle with individual rooms surrounding it, which I thought was good as it is better for the purpose of isolation. We visited the first patient who had a recent travel history abroad. He had some non-specific complaints of a sore throat but generally appeared to be alright. I couldn’t believe that I was seeing my first patient afflicted with the coronavirus . I don’t know why I was so surprised, maybe because the media portrayed the situation in such a horrible light that I pictured only coughing and breathless patients. As the other physician had already developed a rapport with everyone, he knew everybody’s history properly along with their current medication. In all this, I already started to sweat inside the suit and was generally feeling suffocated due to the tight mask.
I had the silly thought of taking short breaths as I correlated less air with fewer germs, which was really stupid, considering the 11 years of rigorous medical education I had undergone. Fear literally makes you forget everything.
Thankfully, all the patients were stable and most of them were there since about 10 days. As these patients didn’t have any acute medical issues, other than their routine tablets, talking to them was one of the most important interventions from our end. Could we imagine how would it feel if we were to test positive for the virus? We would be socially isolated in an unfamiliar environment until the repeat test came negative. What would the repercussions of this situation be on our mental health? Taking care of the patient’s mental health, giving hope and reassurance is thus an equally important part of the medical practice.
The government authorities had also made a dedicated COVID-19 hospital for admitting positive as well as suspect patients which I visited, and thought was impressive. The main physician introduced me to the nursing staff and ward boys saying that I would be in charge from tomorrow, and that they should call me if anything happened. Unsure about how to react, I just nodded, grateful that the suit and mask did such a perfect job of concealing my face! Finally, after taking a round of the entire ward, we removed the PPE. As expected, my clothes were completely drenched with sweat as if I’d been walking in the Sahara Desert. I thanked the physician and drove back home. I was extra careful not to touch any surface while going to my newly-made quarantine pad. That day a lot of people called and messaged me to get to know the exact number of cases and about my experience in general. After a long day, I finally hit the sack, trying not to worry about what was in store for me in the coming week.
The next two days were uneventful. I finally got the hang of wearing the PPE, and spent my time trying to build a rapport with the patients. As doctors, we are an important part of any patient’s life. Some people pour their hearts out to a doctor, not only in describing their ailment but also talking about other issues which are bothering them. So, we invariably get attached to certain people who share everything with us. I cannot say I got attached to the patients I was examining, but I definitely took an interest in a few particular patients. There was one patient who was not only doing well physically, but also sound mentally. He was cheerful and would always think positively. The courtyard had some potted flowering plants. This patient would water them daily, which I thought was a lovely initiative on his part. When I complimented him for it, he told me that plants helped him stay positive and brought him mental peace.
For patients in the COVID-19 ward, the protocol was that if two throat swabs taken 24 hours apart come negative after 14 days of isolation, then the patient could be discharged. I saw that one patient had completed 14 days of isolation, so I sent his repeat throat swabs and to my relief, both came negative. I could see the relief on his face when he heard the news that he was being discharged.
That day, I felt happy that I could discharge a patient who was suspected to be coronavirus positive amidst the increasing numbers. As they say, every drop makes an ocean!
Then there was a family comprising of the father, mother and son, all of whom had tested positive. They had almost no symptoms, but mentally, they were always worrying about their five-year-old daughter. Fortunately for her, she was found to be negative for the virus and was admitted in another ward in the same hospital. Whenever I would ask the parents how they felt health-wise, they had only one answer, “We are fine, but please see that our daughter is taken care of and well fed!” Thus, I would check on the daughter every day and see to it that she was given proper meals.
The next few days, the ward saw a sudden increase in the number of patients, but fortunately all were stable. The only time I was taken aback was when the nurse informed me that two of the new patients were only 11 and 13 days old, respectively!
Luckily, they did not have any symptoms and were found to be positive through contact tracing. The paediatrician also came to examine the infants daily, but I would also make it a point to talk to their mothers, who had also tested positive. They liked the fact that two doctors were coming to check on them daily. I believe that making sure the patient’s voice and concerns are heard restores the faith of the public in doctors.
Once after a tiring day, I got a call from the hospital at 10 in the night that 16 new patients had been admitted and that I would have to see them right away so that they could start their treatment.
When I reached there, I was relieved to find all of them stable, but at the same time I was surprised to know that all of them were police personnel who were posted at various places in the city. Unfortunately for them, they came positive while answering the call of duty.
The police force is another cohort that is targeted for the wrong reasons. I believe that there are negative elements in every profession, but that doesn’t mean that the whole profession has to be maligned. My respect for the police grew that day.
The rest of the week flew by, and to my astonishment, I was at the last day of duty. I would remember that day forever, only because I had to stay in the PPE suit for six hours in one stretch. It drained me physically as well as mentally. I had to see many patients that day, and also inform the nursing staff that I would not be coming from the next day as I would be in quarantine. I finally removed the PPE and drove back home, utterly exhausted. I don’t usually sleep in the afternoon as I think it a sign of laziness, but that day I slept like a log. However, the evening held a pleasant surprise.
We all know about this sudden obsession with video calling, and my family wasn’t too far behind. That evening, my close family members held a Zoom meeting with me. All of them gave me a virtual applause from their own homes. I was really touched by their gesture. I was also happy to inform all my friends that I had finally finished my duty and would be available for online Ludo sessions. The next day when I woke up, it felt nice that I did not have to go to the hospital, but I also realised that this is definitely not the end.
As cases continue to multiply at an alarming rate, I know for a fact that I will have to do another duty again soon and that duty could be marred with complicated cases along with an immense workload. Whatever the situation, I will always be prepared.
But here, I would like to talk about the plight of doctors and healthcare workers in general. We all are here to protect the public and do our best with whatever resources we have. Be it a super specialist, a post graduate doctor, a nurse, or a ward boy, we try to ensure that the best care has been given to every patient. But the public perception about doctors needs to change. On the one side we see people clapping, banging utensils, and showering petals for doctors and medical staff, only because the prime minister said so. On the other hand, we see people from my fraternity being socially outcasted and thrown out of their homes for working in COVID-19 hospitals. This really is unfair. I agree that there are negative elements in every profession, including the medical profession. But that does not mean that the public should generalise this perception and harass the people who are genuinely working to ensure everyone’s safety and well-being in this pandemic.
This pandemic has really shown me my place in this world. Whenever I used to wear the PPE suit, there was no indicator of whether I was a consultant, a staff nurse, or even a ward boy, as everyone working in that environment used to wear the same suit.
Whenever I would go to the ward, I had to tell everyone that I was the consultant to get their attention. This taught me one very important thing, that ultimately every human on this earth is equal. Some of us are fortunate enough to be born with silver spoons in our mouths, while others aren’t so lucky.
But we should treat everyone equally, with dignity and the respect they deserve. As they say in Hindi, ‘Koi bhi kaam chota ya bada nahi hota’.
After this pandemic settles down, my only hope is that people realise the importance of healthcare. By people, I also mean the law makers and the bureaucrats. Investing in infrastructure projects like the bullet train may sound cool, but I would like to point out that there should be people wanting to ride it in the first place, and that entirely depends on their health! Hence, this is a sincere appeal to consider healthcare as an investment, I assure you that investing in our collective health will give returns like no other!
The author is a physician at Dr Vasantrao Pawar Medical College Hospital and Research Centre in Nashik, Maharashtra
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