* “It feels like you are in a hot plastic suit and it’s suffocating,” Dr Ganesh says
* Many doctors are traumatised by the death and sorrow that they see around them
* Doctors complain of sleepless nights, anxiety and a feeling of restlessness
It’s the dawn of a new day; and hope battles despair. For doctors across the country, it is not just another day. As they deal with the trauma of Covid-19, they speak of the dread that surrounds them: Hearing of the death of patients around them, news of hospitals running out of beds, ICUs in need of ventilators, oxygen supplies being sourced from netizens and people crying for help across social media platforms.
Despite the tragedies, though, there is always hope, Sreekumar and Ganesh — doctors from a Covid-19 hospital in Maharashtra — stress. This is their story: A day in the life of the two doctors.
Dr Kumar and Dr Ganesh enter their hospital — and walk down a quarantined corridor only accessible to doctors, nurses and other healthcare staff. “Even the elevators are designed in such a way that no one can enter floors other than the Covid-19 ward,” Dr Kumar says.
They enter a room, the ‘tolling area’, where they wear their Personal Protective Equipment (PPE). According to the World Health Organization (WHO), the PPE “includes gloves, medical masks, goggles or a face shield, and gowns, as well as for specific procedures, respirators (i.e., N95 or FFP2 standard or equivalent) and aprons”.
It takes 20-30 minutes to wear the gear and even before they are done, they start sweating. The rooms in the Covid-19 ward are not air-conditioned, mainly because the virus spreads in an air-conditioned and non-ventilated space.
“It feels like you are in a hot plastic suit and it’s suffocating,” Dr Ganesh says. “Towards the end of your shift when you remove your PPE, you are drenched in so much sweat that it can fill up a small bucket.”
In a pre-pandemic world, doctors usually moved from ward to ward or were called as and when their expertise was needed. Not anymore. “I first saw about 40 patients and it peaked to nearly 120 patients at a time in the ward,” says Dr Kumar.
They take their rounds, monitoring the conditions of each and every patient and speaking with early shift doctors. The doctors have shift duties, and the working hours — eight, ten or more — vary from hospital to hospital, Dr Ganesh adds.
There are varied obstacles and tasks that the doctors face; worried patients who are concerned about their condition, those whose health parameters rapidly deteriorate in a matter of hours, treating the mounting load of cases without a break, and, worst of all, informing the news of the death of a patient to the family.
Dr Kumar recalls that in the first phase of Covid-19, doctors and scientists alike were unaware of how to treat patients — after all, this was the very first global modern-day pandemic. “We didn’t know how the virus behaved nor were there any vaccines available,” Dr Kumar says.
“Last year, the virus largely infected senior patients but now many youngsters are testing positive and are even dying,” Dr Ganesh adds. “People used to have symptoms of respiratory-related illnesses but it has now evolved and patients get diarrhoea, among other things. Now, fungal infections are on the rise, too, which are extremely dangerous.”
A part of their job now, they say, is in reassuring patients and their relatives. Dr Kumar recounts the case of a nervous 71-year-old female patient. “When I read her name on the list, I realised that she was from my home state,” he says. To make her feel at ease, he spoke to her in their common native tongue.
“Her behaviour changed and she started trusting us and our care. She began eating well,” he says. “Later, when she was discharged, her son called to say that they kept waiting for me to thank me in person but I wasn’t on duty that day. It felt nice to know that they valued my care.”
Apart from dealing with stressed out patients or the virus itself, doctors are also overwhelmed by an unstoppable tsunami of cases. Unending queues outside hospitals and people waiting for hours to buy medicines have become common sights.
Death of a patient is something that most doctors are prepared for. What is traumatic is conveying the news to the patient’s loved ones. Earlier, the doctors would speak with the family and explain the conditions that had led to the death. “We counselled them and gave them some time to grieve.”
But Covid-19 has cruelly changed this regimen too. Comforting a dying patient in bed and holding their hands is not an option anymore. Social distancing has almost made it impossible for a critically-ill Covid-19 positive patient to be visited by their family. Further, so many of the deceased are young people, the doctors point out. “How do you tell the family of a man in his 20s or mid-30s that their son or husband has died,” Dr Kumar asks.
When informing a family about a patient’s deathdoctors brace for a wide range of reaction: Denial, blame, shock and anger. “No you did not treat them well, he was okay yesterday!” the relatives often scream at them. They hear words that leave them broken: “He was the only earning member... now how will we manage?”; “Sir he was so young”; “I didn’t even see him”. Dr Kumar says, “You don’t know what to say when they say something like that.”
In some cases, relatives have turned violent too. Videos of relatives attacking doctors have spread across social media. In a recent statement, the Indian Medical Association (IMA) said violence against doctors in India was “an emerging epidemic” in itself. “There needs to be urgent corrective actions at various levels to bring a halt to this heinous crime. A stringent law and strict enforcement are the need of the hour.”
The dark mind
With so much death around and working in a suffocating plastic suit, it’s exceptionally hard to be in the frontline. Yet doctors continue to do their task every single day. But what goes on in their minds?
Dr Siddhika Ayyer, consultant psychiatrist, Gleneagles Global Health City, Chennai, says, “When the pandemic began, the first and foremost fears and concerns among doctors or any healthcare professionals were if they would infect their family and if they would be able to see them.”
Today, many doctors are traumatised by the death and sorrow that they see around them. Doctors are also greatly affected by the rise in cases among the young. “When they see young patients in their 20s or 30s succumbing to the virus, it naturally leaves them shaken,” she says.
The Maharashtra doctors agree. “When you see an old person passing away, you tell yourself, ‘Okay they have lived a long life’, but when it’s somebody young, it’s very hard,” Dr Ganesh says.
How are doctors counselled? Dr Ayyer says that a vital part of counselling is just listening to them. “There is no a one-size-fits-all solution for this. Each and every doctor will have their own set of mental stress,” she points out.
“What counsellors do is process the information doctors share with us and help them come out of the grief for the patients they have lost, lift their morale by also reminding them that several other patients they have treated are back to leading normal lives. If there’s one patient who is dying, there are ten others who are surviving.”
Dr Ayyer says that the doctors complain of sleepless nights, anxiety and a feeling of restlessness. Counsellors advise them to stay away from anything related to Covid-19 after returning home from work. “That’s why we tell them to not to watch the news. Too much of pandemic news on deaths will leave you drained,” she notes.
They urge doctors to occupy themselves with activities that “dissociate themselves from their work” — something such as exercising, cooking or listening to music.
She also adds that in her experience so far, doctors haven’t shown symptoms related to Post Traumatic Stress Disorder (PTSD) yet. “They are still facing the pandemic and we might have people with PTSD once this subsides,” she warns.
Dr Ganesh and Dr Kumar’s shift comes to an end. They take a final round and pass on the day’s report to the next doctor. They walk into the “doffing area” to remove the PPE and carefully dispose it. Their sweat drenched body finally receives a breath of fresh air. They return home and do their best to forget whatever happened at work.
“I sometimes relax by watching some comedy shows,” Dr Kumar says. The two doctors also spend their time studying for further specialisation.
The last thought, before they nod off, is invariably about the following day. Maybe tomorrow will be a better day, they think.
The next morning, they are up again at the crack of dawn, ready to take on the day.