TO WALK AN EXTRA MILE - An account of life in Critical care in times of Covid
by Dr. Anoop Sebastian @ Treat by Alterdoctors
I was deputed for covid icu duty when the covid crisis was at its peak. As with everyone I was apprehensive, worried for my own safety and my family.
I went for work on the first day and started the doning procedure, knowing it’s for real this time, unlike the simulation scenarios previously. With all doning required, an extra surgical gown and gloves for added protection, I entered the covid icu.
I was welcomed by a resident busy at work, but happy and relieved to see me signalling the end of her duty. I recieved the handover, detailed in written format . After handover I was looking at the surroundings to get a feel for the MICU area and how much it had changed since I last visited.
The melancholy beeping of monitors of the covid MICU hit me first. The staff although in full PPE looked scared, but were doing their duty with diligence. A sense of insecurity was palpable in the atmosphere. Yes, after months of debate and contemplation, we are finally on the frontline of the covid warzone.
I won’t elaborate on the difficulties of PPE, which vary from a tiny itch on your nose to a throbbing headache from CO2 retention to profuse sweating to controlling your bowel and bladder during the shift . Its humanly impossible, but we are surviving it.
After a brief pause to organize myself, I started moving towards each patient. The first thing that struck me was the sheer helplessness in their eyes. Young and old, rich and poor , all scared with a doomed face looking at you helplessly for some comfort . Initially, I was interested in studying the files but later I realised rather than studying the file, holding their hands and reassuring them should be the first step I should take. After that I studied the files in great detail and attended to presenting problems of each patient. I listened to staff at bed side (guardian angels for the patient) and realised I could learn more by speaking to the bedside staff rather than by studying the files.
I was initially taken aback when I found a patient coughing and saw the droplets splashed across my visor and shield. I felt like I was in a biohazard war area, with the covid virus 
fighting your shield and ppe to infect you. I wanted to hold the hands of patients, but the viral load in the environment was making me scared to get too close. I had to dig deep into my inner strength and virtue, and see that I followed all protocols for PPE doning and was protected to the best possible extent. With that reassurance, I forced myself to take utmost care for each patient as a member of my own family, for truly, we were the only family each patient could expect in the ICU scenario of this crisis. Another I realised was that each patient was worried more for their own family than his / her health as they knew their family was also positive and fighting the same battle.
Further all patients are scared as they can’t understand what is happening to them. They are all gasping for oxygen, undergoing one procedure after the another, a battery of blood tests being run and the inability to attend to personal needs brings everyone to the brink of a psychological collapse. Their need can be as trivial as a doctor just standing beside them for a minute to just sitting on a chair. Their only communication with family and the outside world is a video call and most are loosing the willpower to fight after a stay of 3-4 days in ICU after witnessing the difficulties faced by fellow patients in nearby beds. They all feel doomed or cursed. We need to think about improving the psychological morale of patients in the ICU with covid which in itself is a different topic altogether from all the different guidelines published weekly in medical management.
Families are helpless and scared, with their voice worrying each time an icu call goes to them to update about the patient, praying that it’s a positive message. The simplest medical language you use will still go way over an average man as they try to understand why a patient admitted for breathlessness needs medicines for preventing blood clotting and require a dialysis for kidney failure. Still, with complete belief in doctors , they give consent . I am not going into the economical implications for the family.
Finally after your shift you walk out following all standard protocols of donning and then it hits you- by any chance are you infected? … You are risking exposure to your family who are innocently praying for your safety and were strictly following all quarantine protocols as advised. The psychological trauma of staying away from your family and distancing yourself from your loved ones is a big cut in your beating heart which keeps on bleeding with every passing moment .
We are bringing our family as well into the covid warzone which multiplies the responsibility in this trying and depressing times.
COVID is a scenario which we are least prepared for, be it quarantine, contact tracing or treatment -the guidelines keep changing. All we can do is to do our best in the best interests of our patients… As was taught - medicine is an art of amusing the patient while nature cures the disease.
Although news of hospital attacks dishearten me , it’s the fault of the very system in our country which led to a deficient trust in the sacred bond between doctors and patients . Yes, it was broken by some isolated events, but more so by the irresponsible media reporting and by unscrupulous politicians taking advantage of the system for their own personal gains. The funds spent on healthcare is a very meagre amount of our GDP. What more could we expect?
I remember reading a whatsapp forward, nobody taught me in medical college how to convince patients that we are doing all in their best interest , which is why even after trying our best for patients, they still feel like the care wasn’t enough.
Despite hearing your fellow colleagues falling prey to COVID and watching staff collapse in the ICU in PPE, we still move ahead, walking an extra mile for the patient till his last breath only because of the support of family, colleagues, consultants and head of department supporting you , and your teachers from the school level to medical school who have moulded you into the covid warrior you are now , which the society demands in this crisis.
The whole medical fraternity is in this war together fighting this pandemic. I request the society also to walk an extra mile following the norms of social distancing and quarantine and support the Covid warriors in every way they require.
We will walk an extra mile till our last breath.
Dr. Anoop Sebastian
DNB Resident- Anesthesiology and Critical Care