MY COVID DIARIES

When the COVID-19 pandemic struck the nation, and lockdown in various degrees of stringency followed, the way we practiced medicine had changed drastically. Out-patient department that used to be bustling with activity, full of patients often even on days that weren’t scheduled as OPD days were shut down. Numerous patients, especially those requiring close follow up were on regular touch through phone and Whatsapp, that ensured regular dose titration and better glycemic control. Already the patient consultation had shifted to the telephonic follow ups and a few zoom web meeting sessions

especially those who were in critical need of follow up, like type 1 Diabetic and gestational diabetic patients

While the way patients were being seen was changing, the pandemic was slowly but surely creeping up with our hospital becoming the hub of COVID response for the Indian army. As the initial preparations were put in place with diligent planning and military precision by the head of the institution and his administrative team, the physicians and the paramedical staff were gearing up for the task ahead. Considering the nature of the disease, the wards for these patients would have to be contained within a zone, with little movement or mix up with rest of the hospital. So, a management team had to be set up within the zone to stay for a fixed tenure, before being replaced by the next one. Having seen the preparations from close-quarters, and the efforts being put into the task, I was overwhelmed by the way this was assuming challenging proportions. Energetic leadership which was inspiring and being one of the senior physicians in the team, I personally felt the need to step forward and take on the responsibility of working in the zone. This would not only pave way for the others to follow but also give them the confidence in these times of uncertainties and undue fears. With no prior experience, all I knew was I had a task at hand, where I should be not found wanting in the way I stand up and deliver. How and what was the way ahead, I decided to take it as it came.

After gathering some basic information about the treatment protocols, national guidelines and military advisories, which were flying thick and fast, I packed my stuff for the 10 day stay in my own office, which was now a part of the COVID zone. It felt almost surreal, living where I worked all these days, but may be this was serendipitous. Instead of “Work from Home”, this was going to be “Live in Office” for me. As I always would do, when I travel out, I carried my running gear, my yoga mat and other fitness accessories amongst other things, to ensure I maintain that one hour of me-time that was so necessary, whatever be the task at hand.

At the entry to the contained zone, the ominous looking warning signboards welcomed me.

There was a world within the hospital premises, details of which I wasn’t aware of till this day. After usual pleasantries, I got into the brass tacks, changing into the PPE which itself was like a “ceremonial attire” consisting of multi layered caps, hoods, masks, goggles and thick waterproof protective clothing with hardly any air circulating inside. It was uncomfortable enough to cause excessive heat and sweating. Being in it for hours while taking rounds was going to be a challenge, but considering its protective potential against the virus, I knew it was essential. A detailed round was taken of various wards, and I soon realized that I was in a zone, which was a full-fledged hospital in itself. From critical patients in the ICU to those with varying severity of disease in the other wards, most patients were asymptomatic or had mild insignificant symptoms. Managing the critical was medically a challenge with no definitively proven effective drug available. Most of these patients required oxygen and added drugs which may work. Aim was to sustain them with supportive care, try all available drug options and hope for recovery.

In a couple of days, I realized that this virus was not just affecting the lungs of the patients but its impact was far beyond. These patients were not to be treated as how we usually would on a regular basis in a hospital. These were patients, who came into the hospital, with a label of “COVID-19 positive” and irrespective of how this virus made them feel physically, they were shattered by the diagnosis, thanks to the information prevalent in media over the past few months, consisting of images of overwhelmed healthcare in the US and Italy and dying and the dead in the crowded municipal hospitals. The worst case scenario was what the patients and their kin were staring at. As soon as the news of them being “positive” was made aware, they were immediately asked to stay away from their families and close relatives, and asked to immediately get hospitalized. Their next of kin were asked to quarantine themselves at home and often harassed by their neighbours.  And when the patients landed in the hospital, they were whisked away to a contained zone, where “masked” men and women (doctors and paramedics) attended to them. Those requiring oxygen were segregated into more critical care wards and the rest asked to get into a general ward. Often surrounded by strangers, who had their own stories to share, but they all shared the common bond of being “positive”. 

Although initial apprehensions and fear of the unknown made even the doctors and the staff to stay away from the patients, with time we realized the need to connect with these patients. Although as unknown, faceless, masked strangers, who lacked the human touch literally, thanks to the triple layered gloves, we still had a responsibility towards these patients to allay their anxiety, lend an empathetic ear, speak soothing words and be their kin, over and above being the physician. 

So, when rounds were taken, when we would normally look at the patients’ condition, health parameters and decide on treatment aspects, I was also making small talk, enquiring about their families, how they felt about the virus, and what I could do to help them. Out came pouring their emotions, at least some of them, who wanted to speak to their children and spouses, but had run out of telephone battery. They had left their homes in a hurry, too mentally preoccupied with the diagnosis, to remember to pack their chargers. There were some, who were systematic enough to carry all their necessary documents and medicines for their co-morbidities, while some had no idea, as they had someone at home who gave them all their needs. For these folks, we had to call up their homes to find out the details of all their illnesses, and drugs, before initiating the complete treatment. For some elderly, while just talking to them made them feel better, it was often a herculean effort with some to communicate, overcoming their hearing and visual impairments. 

In doing so, there were numerous experiences in human interactions, which were overwhelming to say the least. These stories would deserve a separate blog.

To do all this wearing the uncomfortable PPE in the hot summer days in Delhi while taking rounds in a hospital with more than 200 patients was a test of all the patience I had at my disposal. But something told me, that this was the only way, I could fight the impact of this disease on these patients, where we were doing little by the way of drug treatment. I also realized that how I did all this was being watched by my subordinates and colleagues, and that was the best way to inculcate these practices in them to be emulated. No amount of verbal briefing would help in doing so.

Elderly veterans who often had comorbidity like heart diseases, diabetes and hypertension, were a high-risk category for complicated COVID disease. Often having to spend enormous sums of money in the corporate hospitals or discomfort of municipal hospitals brought them back to their fold, the military hospital. They deserved it and had to be treated with due respect. 

Extraordinary times that we live in requires some “moving out of the comfort zone” actions. So, while normally the next of kin would be able to meet or communicate freely with the patients, and see them once in a while, now they were unable to do so. That raised their apprehensions, fears, further compounded by the misinformation and myths in media.  The treating team, especially the physicians had the responsibility in this setting to take calls from the families and relatives of the patients and convey the status of the patients. While this was often bordering on being irritating and time-consuming, utmost patience was needed to carry on with this, and being empathetic and putting oneself in the shoes of these people helped endure it.

The main focus was on the patients, as it always is in a healthcare setting. But I also had to remember that the numerous frontline healthcare workers like the housekeeping staff, cooks, logistic and administrative staff, laboratory and diagnostic services staff, nursing  assistants and junior doctors who were at high risk of being infected themselves had to be amongst the patients, working tirelessly. To be able to continue doing what they were doing, required not just their own dedication and self-discipline, but also due recognition and motivation by their senior colleagues in the team. Regular chats with them often in a lighter vein, enquiring about their requirements, any apprehensions and applauding them for the tough job they were doing, helped galvanize them into a more pepped up team. I decided to cheer them up and recognize their efforts by earmarking a day for each of these groups, and posting a picture with them, for all in the hospital group to see and applaud. This not just made them proud of themselves but also brought the unsung heroes to the forefront. The housekeeping staff, often a silent subdued lot, gathered courage to ask me for waterproof gumboots to help them work safely in wet areas, which was promptly arranged, thanks to the proactive efforts by the commandant. One could feel the relief and pride in their body language the next day when they walked out to work wearing their new boots.

All this was a task that had to be done, and the only way to do it was real time learning being taught by the daily experience and applying it the next moment. Support from the head of the hospital, and the administrative staff was immense. The commandant, who took a close look at all the happenings everyday and kept me guided with his wisdom and extraordinary foresight made the logistic exercise easier.

While this was a hectic period, I didn’t want to part with my precious me-time, that one hour in the morning when I am alone with myself, and running.

As running was not advisable within the infected COVID zone, I chose the short winding lanes away from the zone, which gave me a 1km loop, enough to get my daily fix of 5-7km. I even managed a 11km run on a day when I was a bit relaxed, and had to participate in a global virtual marathon relay.

This zero hour in the morning gave me the much-needed boost of endorphins, and sweat, that felt refreshing after a bath, and I was all set to get into the PPE for a long round, often 3-4hrs till lunch. This also left me with all the positivity I needed to interact with the patients and listen to their woes.

Overall, these 10 days left me with a great sense of satisfaction of having been actively involved in managing a busy hospital zone. Last time I had felt so, was during my days with the infantry units involved in fighting the dreaded militants in Kashmir. This virus was in fact worse, an invisible enemy. Living in the zone with the men who fought with me, sharing their challenges and doing my best for them gave me immense pride. While so much was being heard about this disease, that to get a first hand experience of getting up close and personal with these patients, that too over 300 of them, gave me a strong sense of achievement. It has enriched me with loads of knowledge and experiences I shall always cherish, and I hope it shall make me a better physician and more importantly, a better human being.