Young doctors ‘overwhelmed’ as beds, oxygen shortage leaves patients gasping

Sanjay*, a resident doctor at the Government Medical College in Nagpur, agonises over how he could do nothing as patients collapsed to death right in front of him.

“We are unable to help them because there are simply no beds and oxygen supplies for all the patients flooding in,” he says. The situation is so dire amid the second wave of the Covid-19 pandemic that even three patients are put together in one bed oftentimes, he says.

It is the helplessness beleaguering healthcare workers that gnaws at Sanjay the most - coupled with simmering anger at what he calls a failed healthcare system - because this is increasingly rendering healthcare workers like him mere bystanders as patients’ oxygen saturation levels plummet and they beg to get admitted. “I would be lying if I say I have not been breaking down after reaching home in the past 15-20 days,” he says.

“We feel so helpless; we wonder what the point of our education was. Because they are dying of preventable causes - a lot of these deaths could have been prevented if we had the resources (enough resources),” the 26-year-old laments.

Ever since the second wave of the pandemic started, the healthcare system in India has been teetering on the brink, with many hospitals unable to handle the relentless inflow of patients whilst also running short of beds, oxygen cylinders and other essentials.

Healthcare workers BusinessLine spoke to say that amid crippling shortages of hospital beds, oxygen supplies and essential medicines, they are grappling to save patients. And many healthcare workers, like Sanjay, are bogged down by the sinking realisation that many lives could have been saved had there been enough beds, oxygen supplies, ventilators and other resources - if the healthcare system had been better prepared for the second wave.

“We are standing helpless as people are dying in front us... their relatives are crying and begging us to do something. It’s really distressing… it keeps haunting me,” said Sanjay.

The medicine casualty department at his hospital, which has a capacity of 19 beds, has been handling over 40 patients, at any given point of time, in the past ten days or so. They are forced to turn away many patients. The first wave of the pandemic pales in comparison, he says wryly.

Tanya*, 26, a postgraduate doctor at the Nesco jumbo Covid-19 centre in Goregaon, Mumbai, describes the impact of the second wave succinctly, “It is definitely worse than last year. It's not a second wave - it's atsunami that is happening.”

Just as people were dropping their guards assuming that the worst was behind them, India was hit by a second wave of the pandemic, the magnitude of which is rendering its already precarious healthcare system more overburdened than ever. India has been reporting over two lakh cases a day in the past few days, making it one of the worst Covid-affected countries in the world. News and social media are rife with harrowing accounts of overburdened hospitals, people scrambling to secure oxygen supplies and medicines, morgues piling up with bodies, and funeral pyres flickering away late into the night amid soaring deaths.

Most of the healthcare workers BusinessLine spoke to wished to be anonymous - with some not even wanting their department names to be mentioned - as they feared repercussions from the authorities; some also said they have been explicitly asked to not speak to the media.

Healthcare workers say that the new strain of the virus amid the second wave is more virulent and infectious, which is leaving more young and healthy people in critical conditions compared to before.

“This time around, even the young are not spared. And the lung involvement is like really, really high. We are seeing people in the 25-30 age group dying,” says Sanjay grimly. Nirav*, 26, a general surgery final year resident doctor at Mumbai’s JJ Hospital, says that during the first wave, half of his patients needed oxygen off a mask, but now, his entire ward needs oxygen through masks.

Many of them recount disconcerting accounts, pointing at the humanitarian crisis that is unravelling as the reinvigorated pandemic rages across the country.

“I can tell you accounts which are so chilling that it is like quite unimaginable,” says Sanjay.

On April 16, there was a woman aged around 60 in the medicine casualty at his hospital - GMC Nagpur - whose oxygen level had plummeted to 80 at around 2:30 pm. She had also tested Covid-positive. But she was forced to share the bed with two other patients as the hospital continued to remain overstretched, which also meant that she was getting only one-third of the oxygen she was supposed to get as the oxygen supply was also getting shared among the three patients. By evening, her oxygen level further dropped to 60-70 and she was still only able to get one-third of the oxygen she needed. Her son, who couldn’t bear to stand this anymore, decided to take matters into his own hands. He somehow managed to procure a jumbo medical cylinder from elsewhere, but just as he rushed to the hospital with this, a mere five minutes later, his mother stopped breathing, Sanjay recounts.

“I was totally broken seeing this,” says Sanjay.

Others, too, speak of how the deaths are happening at an alarming rate because of the lack of proper health infrastructure. Apoorwa Verma, 24, a resident doctor at the South East Central Railway Hospital at Bilaspur, Chhattisgarh, says that while the new strain of the virus is very dangerous, people are dying mainly because of the lack of beds, ventilators, medicines, injectables and insufficient hospital arrangements, referring to the condition in Chhattisgarh. Her hospital was sent a notice by an RT-PCR lab asking them to stop testing as they are having over 4000 pending tests to be done, a testimony to how the healthcare system is getting choked amid the surge in cases.

Panic has become pervasive. For the past ten days, Apoorwa has been swamped with desperate calls from friends and relatives asking if she could arrange beds and the antiviral remdesivir injections, she says.

Anger at the government is also palpable among many healthcare workers for not being prepared for the second wave and for having been caught napping yet again. “We can understand that they were not prepared for the first wave of the pandemic, but after more than a year, they should have been prepared for this wave,” says Syed Faizan Ahmad, 26, a surgery resident at Silchar Medical college, Assam, echoing the sentiments of other healthcare workers, too. India spends only around 1.6 per cent of its GDP on health. “This is despite (more than one year of) the pandemic. It is very shameful,” says Nirav.

‘It is grossly low and that is coming up now,” says Sanjay.

They also express anger at the way tens of thousands of people have been gathering for election rallies and the festival of Kumbh Mela despite the grave risks of doing so amid a pandemic. “It boils my blood,” says Tanya.

While all this has been unravelling, healthcare workers like her are faced with the task of attending to surging coronavirus cases that is leaving the country’s healthcare system crumbling.

“The sudden deterioration in the condition of patients that is happening right now in front of our own eyes, despite us trying our best to manage them, is completely disheartening. There have been so many deaths on a daily basis, because patients are just getting that bad. There have been patients who had increased blood sugars - but sometimes insulin isn't available,” says Tanya.

“And there are days when you see so many deaths and morbidities that it inevitably takes a toll on your personal life,” she said, adding, “It is all you can think of - that one particular patient who got unstable and who had to be shifted to the ICU, that one patient who got a heart attack in the ward...and it keeps going on in your head.”

Like Sanjay, JJ Hospital’s Nirav also rues how doctors like him are forced to turn away patients as there are not enough beds. What angers him the most is how there have been no recruitments at all in the past year, with many senior doctors’ positions remaining vacant at his hospital. This has also meant that doctors from other departments and specialisations - like general surgery in his case - are also roped in for Covid-19 duties owing to the manpower shortage.

There are just not enough doctors or healthcare workers, especially given the spike in coronavirus cases, affirms Syed, adding that this is also having repercussions on those patients with other critical illnesses as they face inordinate delays in getting treated.

Nirav’s friend, who is also a doctor at JJ Hospital, tested positive recently and though she was symptomatic and required admission to a hospital as per the guidelines, she, too, couldn’t get a bed. “The situation is this bad that despite being a doctor, she could not get a bed,” Nirav points out. “There is even a shortage of the basic stuff - I am buying my own masks now. And the quality of the PPE (personal protective equipment) is also compromised,” he adds.

The situation appears to be similar in most places - only the extent and kind of shortages seems to vary.

Tanvi Grover, a final year resident doctor in the department of anaesthesiology and critical care at Safdarjung Hospital, Delhi, says that her hospital, too, is struggling with shortages of medications like remdesivir.

She heaves a sigh when asked how she has been dealing with the second wave. “See, it’s definitely nerve racking … And the shortage of supplies is also definitely a drawback. Working in the ICU, seeing more deaths, seeing the shortage of supplies and the hunt for medications - all this is definitely something that's creating a horrifying situation for all of us.”

Varun*, a second-year postgraduate resident doctor at AIIMS Patna in Bihar, says that oftentimes, the anger is also misdirected at healthcare workers for the lack of beds and other essentials. “Doctors are getting abused for not providing beds. How can we provide beds to a patient? It is not in our hands. You never voted for us; it was the government you voted for, right?”

The problem also lies in the lack of even distribution of resources, says Varun. The resources and facilities to treat Covid cases could have been made available at primary health centres and secondary health centres, too, over the past year, rather than just focussing on tertiary health centres. “We had time, we could have made the accessibility of resources at these setups. But we lacked over there. And now, we are all bearing the cost of this.”

And the cost has indeed been too much to bear.

Tanya shares some of the many heart-wrenching instances she has been privy to amid the second wave of the pandemic. A week ago, there was a father and a son who were both admitted to the ICU, and she was faced with the difficult task of breaking it to the 58-year-old son that his 80-year-old father would not make it alive.

“I had no words to tell him because he was in an ICU bed, too. His father had a tube inside his mouth, he was being mechanically ventilated, and his son was right beside him. This is such a situation that no child should have to go through,”she says. There was another time when a woman tried to run after her mother’s body, which was being taken to the mortuary after she lost her life to the virus. She eventually had to be sedated.

“These are the things that haunt you at night,” she says quietly. “The whole thing of seeing your parents take their last breath in front of your own eyes while you're incapacitated yourself. That is something that has stayed with me for the past few months. And that makes me think about my parents…,” her voice trails off.

Meanwhile, as the country combats one of the worst crises it has ever faced, some of the problems that healthcare workers faced during the first wave - that still persist - are fading into the background. For instance, Sanjay recalls how healthcare workers like him used to make a huge deal out of the shortage of PPE, gloves, syringes and other basic stuff during the first wave. These feel like trivial issues now, he says.

“This time around, there is no oxygen!” he exclaims, livid. “This is like the most basic stuff you can think about in Covid times - even that is not there. So, I am not getting to the issue of the shortages of syringes and gloves. That is an integral shortage. But we feel that we can at least still do our jobs without it, but without oxygen you can’t carry on, right?”

As he puts it, “We (healthcare workers) want to work, we have no problem in giving our services. But if you don't give us the resources to work with, what will we do?”

His question remains hanging in the air, portending that unless this changes, many lives continue to remain at stake.

*Names have been changed on request to protect identities

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