Story of the fight inside COVID ward #Indian express


 

At this time, where  CELEBRITIES and REEL HEROES are fighting the war on Television to prove their real worth in CORONA-TIMES as if they are of some use to society; entertain.  Trying to prove as if the name, fame and wealth  showered on REEL HEROES was not an overhype, INDIAN EXPRESS has been wise enough to publish the real fight in the wards and plight of REAL   HEROES. As the stories of the real plight remains confined to medical groups only.  This article has appeared on 12 April Sunday.  Now the time has come to worship the  REAL HEROES and not use them as sacrificial lambs, otherwise in next pandemic only REEL HEROES will be available for good dialogues, and not the saviors.

      The hazmat suit can get oppressive, the separation from loved ones painful, and fear of the virus paralyzing. The Indian Express recounts 24 hours in the life of four doctors and nurses on the frontlines of the battle against coronavirus in the Capital, armed with a few PPE kits, bottles of sanitizers, and — when the stress gets unbearable — Mohammad Rafi songs

Soaked in sweat after a grueling shift, every night, she returns to the Dental Block of her hospital to sleep.The goggles and mask stretched across her face all day leave bruises; the heat, she says, has set off pimples. Her limbs ache from wearing a PPE suit a size too small. What she craves then is a bath, but dreads it too.

“My room is not a dormitory, it’s a laboratory. There are three toilets, no bathroom… I use the jet spray to take a shower. Then I wash my clothes near the toilet and hang them on a railing where clothes of 17 other nurses — all of them exposed to  COVID 19 patients all day — are also left for drying. That’s the moment I break down every day,” says the 50-year-old nurse who was assigned to the special ward of a dedicated COVID-19 hospital. “Dar lagta hai, rona aata hai (I feel scared, I feel like crying)… But I just take a painkiller and sleep.”

 

In another part of the city, a 25-year-old doctor, who has been working in the COVID-19 ICU of a Delhi government tertiary care hospital since March 26, is relying on a pill to stay safe. “I have been taking a dose of  HCQS,  I went to 15 shops to get it, but it was not available anywhere. I finally had to borrow from a friend.

Its effectiveness in treating COVID-19 has not been proven but it’s recommended. I know it can have serious side effects. I read that a doctor in Guwahati died after consuming it. But I am taking my chances,” he says.
On a continuous 14-day shift in the COVID-19 ward before he gets a break for a fortnight of quarantine, the post-graduate resident doctor from the internal medicine department says he loves his job, but fears putting the lives of his elderly parents in danger. “The ICU is the most infectious zone. I have to insert tubes through the patient’s mouth into his airways, put food tubes, catheter, if needed… I am constantly exposed to their body fluids,” he says, adding, “My parents are very paranoid, and insisted on taking the hydroxychloroquine tablets too. But I didn’t let them.”

As the country remains in lockdown, with people barred from stepping out of their homes, a large army of doctors and nurses have been making their way to COVID wards each day and night, treating patients even as they fight their own fears. With the novel coronavirus cases in India crossing 6,000, the burden of treatment has largely fallen on the country’s creaking government healthcare system and its over-worked staff. In Delhi, with over 20 virus hotspots and 14 deaths, at least six hospitals/blocks have been dedicated to the treatment of nearly 1,000 COVID-19 patients, and thousands of suspected cases.

 

the six floors of my hospital are brimming with people, there’s hardly any social distancing that happens. Ambulances are dropping off family after family, all suspects. I am not in a PPE kit all the time, so when I first come in contact with suspected cases, I usually have only a surgical gown and a three-layered mask for protection. If any of them coughs, I shudder… At times such as these, I simply plug in my headphones, listen to Mohammed Rafi songs for a few minutes, calm down, and return to the job,” says the 50-year-old nurse.

Before the shift

These days, the 25-year-old doctor begins his day with a WhatsApp video call to his parents. Since the Cardiac Care Unit at his hospital was transformed into a COVID-19 ICU, he has moved to a separate floor of his house.

“I tell them to prepare my food and leave it at the door. I was given the option of staying at a hotel, but my family got extremely worried and insisted that I stay at home,” he says. He also makes calls to a few friends, mostly doctors, across the country, to catch up with them. “They have been my support. I have to admit that I have been calling them more than usual,” he says. The post-graduate resident doctor, who is now three years into his job, has been working in three shifts — 9 am to 3 pm, 3 pm to 9 pm, and the night shift every third day, from 9 pm to 9 am, after which he gets a day off.

Given the infectious nature of the disease, separation from family is a reality for many doctors across the country, like for a 40-year-old cardiac surgeon from a Delhi government hospital who has also been staying on a separate floor of his house.

“In the mornings, my daughters, 5 and 8, come out in the balcony and we shout out and talk to each other. They have also invented a game — they have named me corona and pretend like they are out to catch me,” says the doctor, who volunteered for a position in the COVID-19 ward in early March.

 

“The distance was necessary because my father, in his 70s, has both a lung and heart condition… I have worked in tuberculosis wards earlier, so my family is used to me taking precautions. But this time it’s a pandemic and so the stress levels are higher,” he smiles.

For the 50-year-old nurse, a diabetic mother and a 10-year-old son at home made her opt for the hostel facility at her hospital. “I have been in the profession for 22 years. I married late to focus on my career. My shifts have usually been long, but this is the first time that I have been away from home for this long,” says the nurse who hails from Goa

So now she spends her mornings talking to her child and husband, often “hiding my worries”. “They read about the staff at the Delhi State Cancer Institute getting infected, they ask me all kinds of things. I just say everything is fine. I have also told them that I don’t have a phone with me, so don’t call me till 10 pm. But I have one; I just don’t want them to call me when I am busy with the patients or when I am too stressed,” she says. “Since it’s Lent season, I also pray for the safety of my family before leaving for work. I have bought some dry fruits and fruits from outside which I eat to strengthen my immunity,” she says.

 

As she enters the toilet in the Dental Block to freshen up, she says, she cringes at the sight of the bucket, mug and towel. “They were used by the staff here before us. I don’t know if they have been disinfected,” she says.
But she is relieved that she does not have to go back home after the shift. “Two nurses at the hospital have been travelling from Noida every day. Their families are exposed to the virus. Once my 14-day duty ends, I hope they test me before sending me home. The 50 nurses who worked before us were not tested, just sent for 14-day quarantine.”

Inside the ward

As per norms, and accounts by doctors and nurses that The Sunday Express spoke to, the COVID-19 wards in the Capital are “well-ventilated spaces with beds placed at least six feet apart and no extra furniture”. They are disinfected with sodium hypochlorite several times a day. Separate toilets would be ideal, but at most places, at least three to six patients share a facility.

“The rooms cannot have air-conditioners because that would lead to stagnant air, an ideal environment for the virus to thrive. This also means that a doctor or nurse can’t wear a PPE suit for more than two hours, because it gets very uncomfortable in this weather. It is easier in colder countries,” says the 40-year-old doctor, whose first challenge upon arriving at the hospital is ensuring social distancing among the large groups of patients who arrive at the reception every morning. The 450-bed hospital he works in has 200 COVID-19 patients now.

“I take two rounds of the wards in the day. I use the stethoscope for auscultation, I have to come in contact with positive patients and suspected cases,” he says.

Around seven people, including nurses, security and cleaning staff, are present in the hospital’s COVID ward at any given time. When not in the ward — there are six COVID wards at the hospital, including the ICU and Flu Clinic — the doctor works from a ‘COVID-19 office’ that has been set up at the hospital recently.

“Recently, a man who had returned from Thailand and had COVID-19 symptoms kept holding his little son in his arms. I had to counsel him for long before he agreed to let him go,” he says. Patients with fever, cough and sore throat first arrive at the hospital’s Flu Clinic to get tested. At least 50 patients have been testing positive at the hospital every day.

 

“I then move on to take stock of PPE, about 15 of which are used in each shift, and then go through patient files, and finally brief all my staff — nurses, ward boys, cleaners — on how to deal with COVID-19 patients. I can also easily tell when one of them is scared, it’s on their faces. I try to be jovial with them, that helps,” says the doctor.

For the Goa nurse, the “fear” is mostly a sinking feeling as she slips into the pink kurta-pyjama uniform at her hospital every day. “It’s washed with clothes of all other nurses. I rub a lot of sanitiser over it,” she says. Her hospital has 600 active and suspected COVID-19 cases, while her ward has six positive patients.

“We are four nurses on a shift, and only the one who goes into the ward gets a PPE kit. The rest are in surgical gowns and masks. But suspected cases are walking into the hospital all day long,” she says. She is part of a group of 120 nurses working at the hospital in three shifts — 7 am to 2.30 pm, 2.30 pm to 10 pm and 10 pm to 7 am.
For a 32-year-old nurse, who is now at home after completing her 14-day shift, it was the “donning and doffing of the PPE that left me anxious… We didn’t have a separate room for changing, about six of us did it together. I washed my hand after removing each part of the equipment,” says the nurse who hails from Kerala and has been working at a Delhi government hospital for the past six years.

A single parent who lives with her elderly mother and child, she says she stays in a separate room at her house, uses a different toilet, and pours Dettol all over her shoes and clothes every day. “Unlike doctors, nurses are not tested after the 14-day shift ends. There was no thermal screening facility at my hospital either. So I am continuing with the precautions,” she says. However, she says, she is relieved that she doesn’t have to wear gloves until her next 14-day shift. “I am allergic to latex powder that is used while wearing gloves. My hands would remain itchy all day. I would wash them all the time.”

Washing his hands 20-25 times is also among the many precautions that the 25-year-old doctor takes every day as he begins duty. “Even in the 20 minutes that it takes to wear the PPE, I wash my hands five-six times. I then head to the ICU, where I have four patients now,” he says.

His three years in the job have seen him being posted in infectious wards before and he is “not scared of the work anymore”. “I once got pricked by a needle used for a suspected HIV patient. It was 3 am and I rushed to get a test. It took six hours for the results to come. Fortunately, it was negative. Such incidents will happen, you can’t avoid it,” he says. He will be tested for the virus when his 14-day duty ends.

With no family attendants for the patients, doctors and nurses end up doing a lot more work. “Changing diapers of elderly patients, emptying urine bags… all of this carries chances of infection.”

And then there are the “VIP patients”. “Some of these patients are frustrated at not having found a place at private hospitals. Food complaints are a constant,” he says.

 

VIP patients have made the 50-year-old Goa nurse’s “life difficult” too. “They all have mobile phones, and they keep calling the landlines and our mobile phones, asking for chai, juice, their reports. Once, a patient accused me of hiding his reports… They complain about the cleaner, electrician, ward boy, and they blame nurses for everything. Hum kisko bolein (Who do we complain to)?” she says.

She serves food to patients three times a day in disposable plates and glasses. “It comes from the hospital kitchen — roti-sabzi, dal-chawal. If a patient is diabetic or has any other underlying condition, the diet is changed accordingly,” she explains.

The 40-year-old doctor says it’s normal for patients to be frustrated.

“They are away from their family, there is no emotional support. For a significant part of my shift, I double up as a counsellor. Recently, a young patient sat on the window sill, flung his legs out and threatened to jump. I had to pull him in. I later realised he was a drug addict and was experiencing withdrawals,” he says.

As for his own mental health, says the 40-year-old doctor, “Knowing the science behind the spread of the virus, and not relying on ‘WhatsApp and Facebook science’ keeps me sane. I have been following reports from Wuhan and Italy. It’s going to be a long journey. We can’t lose steam this early. My thoughts are similar to that of any soldier.”
To keep his staff healthy, the 40-year-old doctor also ensures that they eat on time.

“I get my food from home,” he says, adding that the staff takes turns to eat, and ensure social distancing.
The 50-year-old nurse says food is one thing they don’t worry about. “We recently got meals from Taj Hotel. It was very tasty,” she says. However, she has been taking care not to drink too much water so as to avoid using the toilet. “We have to remove the entire suit to use the toilet, and then disinfect. Plus, going to the toilet, which the other nurses have also used, only adds to my stress. COVID shift mein physical se zyaada mental stress hai (There’s more mental than physical stress while in COVID shift).”

So what does she do to fight it? “Apart from listening to old Hindi songs, I lean on my friend of 22 years. We started out together as nurses. We share our concerns and motivate each other,” she says. “I like to take care of people and that is why I became a nurse. But we need some care too.”

After the shift

After a long day at the hospital — that can range between six and 14 hours — the 25-year-old doctor begins his “return home routine”. “I first take a shower at the hospital and inform my parents that I am leaving so that they can leave my food outside my room. There is a sanitiser in my bag, in my car, at entrance of my house, at the door of my room and in my bathroom. I use them all. I keep the used plates and my clothes in a polythene bag outside my room. There is a separate bathroom for washing these,” he says. “My parents often ask me if the risk is worth it. I think it is.”

How often does the fear of contracting the virus cross his mind? “I have thought about it many times. If that happens, I will get admitted at Max or Medanta Hospital,” says the 25-year-old.

As for the 50-year-old nurse, when she returned to the Dental Block on Thursday night, she was filled with hope. “There was a protest by off-duty nurses for accommodation. The doctors are being put up at five-star hotels, why not us? Today we were told that some of us will be shifted to a new place, where there will be two nurses per room and an attached toilet,” she says. “I want to take a proper bath.”

Till then, the painkiller and Mohd Rafi melodies will keep her company for another night.

 

Strengthen hands of medical staff

Over 150 healthcare workers, including doctors and nurses, have tested positive for coronavirus so far. On the frontlines of the battle against COVID-19, the country’s health professionals have so far flagged issues such as shortage of personal protective equipment and lack of accommodation, besides being stigmatised as carriers of the virus.

 For the government, this then is the time to acknowledge some of these concerns and strengthen the hands of the medical fraternity. The ordering of 1.7 crore PPEs in the past week is a step in that direction.

 

Inside the COVID ward- Indian Express

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21 occupational risk to doctor and nurses

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