COVID-19: The Second Wave, a Tsunami - Part 2

Resources overwhelmed:

I stood in the reception facing these patients for a few hours every day, just to let them know that we care and to let my junior colleagues know that they do not have to face it all alone.

One fateful night, the crowd of around fifty patients stood their ground and refused to go back despite our inability to provide them with beds, citing that they had no other place to go, and would prefer to die here in a hospital with dignity than die on the road. These words struck me deep within and I realized how helpless they all were and it should be our duty to help them in whichever way we could. I knew that we had to open up all our doors and let them in. This was the moment for which each of those beds with oxygen had been put in place.

One call to the hospital administration set things rolling. Some wards which were still catering to COVID negative cases, were reassigned to take on COVID positive patients at a short notice. This entailed moving out patients, rushing in staff in PPE and activation of the oxygen supply. All this at late night hours meant actively pushing people into working beyond their usual call of duty and the prompt response from the staff was extremely heartening.

Oxygen scarcity:

As more patients with severe disease were being admitted, the oxygen consumption exponentially increased. This was the scenario across the states and soon a critical shortfall of oxygen cylinders was being felt. There were moments when delay in replenishment of oxygen manifolds led to a crisis like situation endangering patients’ lives.

The support of the military hierarchy was prompt, with oxygen being brought from neighboring states by convoys escorted by armed personnel. With military precision, it was ensured that adequate cylinders were in place for use. Addition of oxygen generating plants, donated by corporates and NGOs further boosted our capacity to self-sustain our oxygen requirements.

Emotions overflowing:

While all aspects of treatment modalities were being addressed for the admitted patients, the shortfall of beds remained, leading to grievances amongst the patients who could not be admitted. A few of them succumbed to their illness waiting for the beds being made available, a sight which was heartrending. The emotional outbursts of the kin who had lost their dear ones was bordering on abuses and accusations. This was difficult to bear, but considering the futility of arguing with them, and understanding their state of mind at that moment, all we could do was to patiently go about doing our jobs, to the best of our ability. The level of patience, maturity and self-control shown by the junior doctors and the staff was admirable. One could sense moments of despair and exasperation in them, but that was when a more mature faculty had to step in and take charge. This was not the time to waste our energy. This was a war against the virus, and all the energy had to be saved for it.

Stress was showing in the medical team as well, with moments of angry outbursts occuring between colleagues for frivolous reasons. This needed stepping in to settle issues amicably and ensuring that credibility of the treating team is not lost in the eyes of the patients or their kin. 

Unprecedented challenges:

Having experienced COVID through the whole of 2020, we felt we had seen it all, till this new wave struck. This one was different. This was far more aggressive as a lung-crippling disease. Almost all the patients who came around day 6-10 of their illness, had already started some form of treatment at home, but were now coming with worsening hypoxia and persistently increasing temperatures. Even the young and pregnant women, those without any co-morbidity were severely afflicted, unlike that seen in the previous waves.

Despite high flow oxygen, with increasing doses of steroid, many of them showed a relentless worsening, succumbing to their illness in a few days. Some had to be put on ventilators which were available, for respiratory support. Even amongst those who recovered, many required oxygen to sustain them due to a significant part of their lungs having been damaged by the virus. This was something we had seldom seen in patients during the last wave. More cases of moderate to severe disease presented in this wave and more numbers continued to require oxygen, even after recovery from active infection.

Undue media hype and misinformation regarding the disease and drugs to be used made it tougher for the doctors to manage patients. While it helped when patients were willing to monitor at home with pulse oxymeters and also procure oxygen Concentrators for use, their irrational prescriptions, excessive self medication with steroids and requests for Remdesivir and Tocilizumab made it difficult for us to convince and treat as per protocol. Many would use pressures beyond professional, to ask for these drugs to be given. Many relatives endangered their own selves and insisted on being with the patients in hospital, which itself was intrusive and a disturbance for the treating team.Responding to them with patience and politeness took a lot of effort. 

While many of them responded and recovered, almost a quarter of those hospitalized were dying despite all efforts. This rate of mortality was unprecedented and the hospital mortuary was being overloaded with dead bodies often more than forty in a day. One could sense the fatigue and despair in the eyes of the mortuary staff as they went about, almost mechanically, packing the mortal remains and transporting to the mortuary. Theirs was a team of professionals who performed a thankless task, but one which no one else could do. They needed their due respect and comforts which was given to them to a great extent.

Management of the mortal remains including the packing as per COVID protocol, documentation, handing over to next of kin and handling of the belongings of the deceased were tasks that required immense sensitivity, diligence and compassion. A lot of what our clientele had to say about the hospital arose out of these processes. While we erred on a few aspects initially, with improving manpower state and from learnings from each mistake, we managed to better on all these scores and could ensure satisfaction in most of them.