Notes from the front line on what it's like to deal with Covid-19

When was the last time he had to inform someone that their loved one passed away as a result of Covid? “Just about half an hour ago,” recalled a doctor.
As the lockdown curbs lift slowly and cases mount in India, health care workers know that their role in the fight against the coronavirus pandemic has only just begun. Here, these vulnerable saviours who risk their lives to save ours share their experience of dealing with Covid-19.

Ankush Garg, Doctor, New Delhi

At 7 am, Ankush Garg wakes up at a 3-star OYO hotel, earmarked for doctors on Covid-19 duty, to prepare himself for the day. He has been entrusted with an arduous task — to take care of patients in the intensive care unit (ICU) at Delhi’s Safdarjung Hospital.

The hospital has three ICUs for Covid patients. The one that Garg monitors has 18 ventilators of which 17 are in use on one particular Sunday. Garg works a 15-day, 12-hour shift cycle, constantly monitoring patients and attending to heaps of paperwork.

When the time comes to intervene, it takes him 15-20 minutes to just put on a PPE (personal protective equipment) kit. “It feels like an oven inside,” says the 25-year-old. Hospital authorities have switched off the central air conditioning to try and stop the spread of the virus. The protection doesn’t always work. “Every time I come out of the lab, I notice I have left myself exposed in one way or the other,” says Garg. “It’s unavoidable.”

He’s not alone. His colleague, Nimisha (name changed), tested positive for the virus. She has since recovered, but has hidden her illness from her family so they don’t worry about her safety. She has been quarantined.

Garg’s patients range in ages — the youngest he has is a nine-year-old with co-morbidities on the ventilator. “The disease makes it extremely hard to breathe. Since there is no cure, we just support the patient’s body as much as we can and leave the rest to their immune system,” he says.

When was the last time he had to inform someone that their loved one passed away as a result of Covid? “Just about half an hour ago,” he says. Earlier in the morning, he was supervising treatment of a middle-aged man who was admitted with severe breathing problems. He had been on the ventilator. He didn’t make it. “His mother knew mine. She called her up, asking about her son, as she knew I worked at the hospital,” he says. “I was just about to inform them.”

Garg spends his morning doing rounds of the Covid ward and treating patients in the ICU. During his breaks, he completes important paperwork, which includes filling treatment charts every hour and ICMR forms for Covid sampling, signing death certificates and making calls to other departments. He coordinates with the nursing staff to transfer bodies of patients, arranging drivers for the job. “The general staff, including the cleaners, maintenance and those who have to transport bodies, are naturally afraid. You have to assuage their fears, provide them PPEs so they feel safer,” he adds.

The mystery ailment has put doctors on constant alert. “Sometimes I am talking to a patient, who is feeling fine. And then within half an hour, he’ll suddenly collapse. We don't know why,” Garg says. He can't be inside the ward for a long time due to the risk of exposure.

On one occasion when workload was low, he was the only healthcare provider when a patient’s condition started deteriorating. He had to intubate the patient. He needed someone to administer the drugs, so he sounded an alarm for the nurse. “She needed 15 minutes to don a PPE. These 15 minutes are always crucial, as the fate of patients in similar situations can be decided in that time.”

The story of a brave doctor, who jumped in to help a patient without a PPE kit, went viral online. Many lauded him. “However, we can’t practically emulate it. The truth is, you’re not just putting yourself but also your colleagues, family and every single patient at risk.”

For 15 days, Garg's routine involves taking care of hundreds of patients, delivering good and bad news to families, and coming back to an empty room in a hotel meant for isolation.

When he returns home after his 15-day shift, Garg is met with an unexpected surprise — his entire neighbourhood is at their gates and balconies, banging utensils, blowing conches and cheering him on as he pulls his car into the driveway outside his house. It’s their way of thanking this corona warrior.

-- Geetika Srivastava

Akshata Pawar, Doctor, Mumbai

Until last week, Akshata Pawar had been lying to her parents back home in Hubli. But when the anaesthesiologist appeared in a video appeal along with her colleagues from Mumbai’s Lokmanya Tilak Municipal General Hospital, she got caught.

Days earlier, a video of the hospital, former known as Sion hospital, was in the news as it showed patients lying next to bodies wrapped in black plastic. Pawar says like her, many other resident doctors had been telling their families that there were no Covid-19 patients at the hospital.

The truth is, several resident doctors, too, have tested positive and half of the pregnant women — many from Dharavi — who have delivered at the hospital in the last month have got the virus. In the labour operation theatre (OT), a patient who had normal delivery became unconscious. “I had intubated her, but a few days later she turned out to be positive and died. Without any symptom,” Pawar says.

She used to earlier work in OTs. Now, besides their regular wards, resident doctors serve in the medicine department ward by rotation. On her first day, a middle-aged man was gasping for breath. She intubated him, but he died. He was accompanied by his wife and teenaged son. “We didn’t have enough ventilators, which could have helped him survive a few days at least. But I felt so helpless in front of the relatives I almost cried and couldn’t sleep the whole night.”

After the shock in the initial days she got used to the endless rush of patients. She is looking after Covid patients for a fortnight from May 13, working in six-hour shifts. But due to the shortage of doctors, she may end up with less than two weeks of self-quarantine. She admits she has turned phobic about getting infected. “The first two days were scary, even to talk to patients and check their vitals.” But communicating with patients is the least she can do, particularly when their relatives sometime disappear for days and don’t even turn up to claim the bodies if they die.

-- Ritwik Sharma

Shashank Singh Baghel, Doctor, Indore

Shashank Singh Baghel could do with adding a notch or two to his belt, but hasn’t had the time. A resident doctor in the general surgery department of Maharaja Yeshwantrao Hospital in Indore, he has lost kilos during the lockdown.

On Covid-19 duty for a week, the number of hours is nothing compared to before the pandemic. The resident doctor would then be on 36-hour shifts at times, and practically remain on call 24x7. But he still prefers that to the eight-hour stretches now when three layers of impermeable protective gear, with no luxury to eat, drink or use the wash-room leaves him sweating gallons and dehydrated.

Baghel, who heads a junior doctors’ association, is aware of how media reports can stir up trouble, in unexpected ways. He recently led a demand for an independent probe against a professor in MGM Medical College. He has accused the professor of abusing and threatening him for refusing to apologise for stories about health risks resulting from pending test reports of junior doctors. “I refused as we hadn’t leaked anything to the media.”

Baghel is asthmatic, so fear of the virus and becoming a high-risk case is real. Many among the 490 resident doctors assume they are asymptomatic. Baghel goes to a rented flat in the vicinity to lock himself up, trying to rehydrate and rest every day. His parents and two elder sisters, who live in Vidisha, have suffered more anxiety than him as they pray for his safety and ask him to return home for good, he says, breaking down.

But he takes pride in the people of Indore. They condemned an initial incident of stone-pelting at health workers and have shown awareness, with some even donating for health care, he says. The confirmed cases in Indore are closer to 3,000 now. “A high number of cases should not be viewed as a failure of health care. Or else the officials might start hiding real numbers.”

-- Ritwik Sharma

Shrinivas D, Ambulance driver, Bengaluru

Before the world changed with Covid-19, Shrinivas D, 37, would spend his days driving tourists around Karnataka, and across borders, into Maharashtra, Kerala, Tamil Nadu and Andhra Pradesh. Now the Bengaluru resident clocks in 12-hour shifts as an ambulance driver.

In the first stages of the pandemic alert, Shrinivas was expected to respond to emergencies where an ambulance was needed, but it’s been over a month since he signed up for Covid-19 duty. Shrinivas is well aware of the threat of working on the frontlines. “Driving is what I know. This is what I can do to help. This is also much better than sitting at home without any source of income.”

As a tourist driver with his own vehicle, he’d rake in an average of ~35,000 per week. Now he gets ~25,000 per month. But Shrinivas has made his peace with this. What is hard, he says, is living away from one’s family when they are in the same city. He hasn’t seen his 12-year-old daughter in well over a month. “I am living away from them for their safety,” he says. “Coronavirus doesn’t really scare me, but I worry all the time about my family in case something happens to me.”

His days now revolve around calls from the Karnataka health services department: he is told where to pick up potential patients from, and where to take them. He largely ferries primary and secondary contacts of those who’ve tested positive, from their homes to testing facilities and back. This routine for every trip has somewhat set into a pattern for Shrinivas and his colleagues, as they use copious amounts of disinfectants to sanitise their vehicles.

He’s lost count of the people he has driven. It’s all in the government records, he says. The number of trips doesn’t bother him as much as the personal protective equipment does. “Never in my life have I felt such an onslaught of heat and sweat than when I wear one of these, but there’s no choice,” says Shrinivas. Things could have been so much better, he rues, if everyone wore masks and took precautions. “They still can.”

-- Nikita Puri

Kavitha Gautam, General physician, Bengaluru

“You can’t hold a stethoscope at a distance of one metre,” says Kavitha Gautam, a general physician, as she talks about how the precautions taken by non-health professionals to ward off Covid-19 may not apply to everyone. Protective gear is worn only when one is working in the Covid-19 ward, and what worries her particularly are asymptomatic patients who might come for regular check-ups.

Gautam is in charge of the Covid-19 set-up at Sir C V Raman General Hospital in Bengaluru, and was in the team that set up the Covid-19 ward there. She spent the entirety of March on ward duty, and recalls how she was terrified of having her two daughters, aged seven and 13, around her. No amount of wearing protective gear, including goggles and gloves, and showering after work could assuage her fears. Time has helped her deal with the fear, but worry refuses to let her be.

Now no longer on ward duty, Gautam continues to be on the front line, testing and screening people coming “in loads” in tempos and ambulances (municipality officers often send people from containment zones), when not treating patients. “Today we sent around 100 swabs for testing,” she says. The weariness in her voice is unmistakable. “It’s about 50 swabs every day. And besides people from containment zones, now we are seeing police and media personnel coming in for tests.”

Gautam has also begun spending more and more time counselling patients as well as those awaiting test results. “We try to tell them that they can recover from this in case they get it but everyone is just so scared because they have a four-year-old at home, are newly married or have ageing parents,” she says. People get particularly worked up at the thought of not seeing their families for the 14 days of quarantine.

Some of this stress passes on to doctors. But her family has been of particular help.

It isn’t just the incessant coverage of the pandemic on television that has shaped her daughters’ understanding, but also her two sisters who are medical professionals and also on Covid-19 duty. “This is all we talk about so the children know what’s going on,” she says. The girls make paper badges, conferring upon her titles such as Best Doctor and Covid Warrior. “They insist I wear these badges,” she laughs.

-- Nikita Puri

Jessica D' Souza, Nurse, Mumbai

“One has to wear PPEs during the day and in negative pressure ICUs, it feels very hot. Many of the staff are getting allergies from the gloves that they wear,” says Jessica D' Souza, chief nursing officer, Global Hospitals. “Easy-to-eat food and some drinks are served in anti-chambers attached to the Covid-19 wards. Nurses take their power breaks there.”

Many nurses, she says, have stayed back in the hospital for over a month now, some even leaving behind their one-year old children at home. Most of the nursing staff is from outside of Mumbai. Some have not informed their families that they are on Covid-19 duty. Many are the sole breadwinners for their families. “One male nurse had a baby about 10 days back but he has not been able to meet the infant as he is on Covid-19 duty,” she says. Despite the challenges, she adds, no one has so far stepped back from the line of duty. In fact, every day nurses from other departments want to sign up for Covid-19 duty, she says. Each nurse attends to one patient if he is on ventilation, two otherwise. In a ward, they attend up to six patients.

-- Sohini Das

Manjusha Agarwal, Doctor, Mumbai

It is more of a mental battle than a physical one, says Manjusha Agarwal, consultant, internal medicine, Global Hospital. The stigma around a Covid-19 patient has to go as this disease is going to be around unless a vaccine comes up, she says. “One of our colleagues was denied access to the elevator and had to walk 18 floors to his apartment where his parents had tested positive.”

She says the earlier routine of seven work days alternating with seven off days was ideal. “Now it has come down to two off days. But nurses and doctors also need to be rested after minimum eight-10 hours of gruelling duty.”

-- Sohini Das

Resident doctor at a government hospital in Mumbai

“Every day we are adding Covid-19 wards. There is no space in the hospital now,” says the doctor who does not wish to be named. “We get PPEs, but those are quite uncomfortable. The worst is that the patients cannot see us, and it makes them very anxious as they are also not allowed to meet their families.”

“We write each other's names on the back and the front of our PPEs. But the glasses fog and our vision is blurred. We cannot drink enough water as that would require us to visit the toilet often,” adds the doctor. “I have had patients pleading with me to take them in, or relatives of patients holding our feet to take in their loved ones. We are running out of capacity and it hurts to see this mayhem as a medical practitioner. We are feeling very helpless. At times more than one patient is connected to an oxygen port.”

-- Sohini Das

Santhosh Kumar S S, Doctor, Thiruvananthapuram

On his Facebook page, Santhosh Kumar, deputy superintendent, Government Medical College, Thiruvananthapuram, shared the story of a colleague, an anaesthesiologist from Chennai, who was sent with a team of 26 doctors to Kasaragod, then Kerala’s Covid-19 hotspot. He was unhappy and considered it a punishment, until he started getting calls and messages from people who hadn’t spoken to him in years, including his father who reached out to him after seven years — each asking about his welfare and telling him how proud they were of him.

-- Gireesh Babu

G Velkumar, Pulmonologist, Madurai

A tertiary care facility, Meenakshi Mission Hospital and Research Centre gets an average of 1,500 outpatients every day, each of whom is screened for Covid-19. G Velkumar, consultant pulmonologist at the hospital, says a constant worry is that a patient might be asymptomatic but infected, or might hide it for fear of being quarantined. For instance, one patient who came through clear in the screening later revealed he had recently returned from Canada, leaving the health staff who had come in contact with him anxious. PPE also causes fatigue, he adds. Those on Covid-19 duty are required to wear it for six hours, “so you really have to concentrate hard to stay alert – and avoid getting infected”.

-- Gireesh Babu

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