It was July 2020 and I was scheduled to start my COVID ICU rotation. In India, we had already observed the plight of health care workers, the inadequacy of PPE and the plight of patients stricken with moderate/severe COVID.
While I was looking forward to being at the frontline, a part of me was nervous. I worried whether I would be up to the challenge. I worried whether I would be enough for the patients.
The first shift of my first day started at 9 pm IST. I hesitated as I entered the donning area. I shakily put on my personal protective equipment and soon enough my goggles were fogging and I could barely breathe. I had already read about these challenges and I was mentally prepared to work in less than ideal circumstances.
Through the fog, I walked into the ICU, into a sea of walking, talking personal protective equipment. The only way to tell one PPE from another was by the name and designation scribbled on the suits. If one ever felt that medicine was impersonal, COVID 19 amplified that feeling beyond measure. I took over from my colleague and started working on my shift.
I had patients of all sizes, shapes, colours, castes, religions, personalities and ages. I had patients with all sorts of diagnoses. The covid 19 could be primary or could be adjacent to the other comorbidities.
While I experienced anonymity during my six-hour shift, this was the persistent plight of patients in a covid ICU. Those patients who were intubated and mechanically ventilated were possibly the most at ease, in my opinion.
My heart bled for those patients who were conscious, yet too sick to move around. They needed help to perform their daily ablutions. They were at the mercy of an already overburdened system. I saw patients who just wanted to pass urine and couldn’t call out for help, because they were breathless.
I saw patients breaking down due to the isolation and the impersonal environment. I saw patients weeping and all they wanted was to go home. We all tried our best to speak to these patients. However, when one has to chose between impending intubation and chicken soup for the soul, one runs out of options.
While each patients misery was palpable and punishing, I will never be able to forget the faces of two children who came into our ICU.
One of these patients was a 6-year-old who walked in unaccompanied. He wore a short-sleeved shirt and shorts. His fingers kept fidgeting as he found himself in alien surroundings. His COVID was incidental but he had an underlying liver condition. He was stable but we couldn’t take any chances.
It was heartbreaking to watch him attempt to take up the least possible space on the huge adult hospital bed. He complied with all treatment modalities, but one could see the anxiety that was so common in the eyes of a COVID 19 patient. We could try to explain his situation to him, but nothing would supplant being in his comfort zone (Whatever that may be to him!). As I got ready to finish my shift, he remained there, quiet and cowering.
The other patient was not primarily assigned to me. I chanced upon him. I was in a tearing hurry to do a blood gas analysis when I heard the wailing of a child. I looked around desperately and found a four-year-old. His head was his prominent part, while the rest of him was emaciated due to a malignancy that he was duelling with. It was during this course that he was detected with COVID. He too was in the ICU due to his coexistent condition.
I asked him why he was crying. He initially wouldn’t make eye contact. He just lay there with the quivering lips and the tear-filled eyes. After a lot of cajoling, he finally whispered, “I want tea”. Something as simple as this filled him with such despair! It may seem trivial to us able-bodied individuals. However, I can’t even begin to explain the extent of disillusionment.
Let me now digress a little. I go back to May 2020. I was wearing a face shield, head cover, goggles, an apron and seeing patients in the outpatient wing. May in India is equivalent to sweltering heat. As I finished seeing my patients, I started experiencing palpitations, chest discomfort and a feeling of being trapped. I soon doffed and felt better. As a physician living with depression and anxiety, I recognised that I had just had a panic attack. I thankfully felt grounded soon enough.
My experience in May 2020, that made me feel like a deer caught in the headlights, probably made me a better covid physician. Or so I would like to imagine!
In my experience, the worst part of COVID 19 was the loss of autonomy, the feeling of being trapped someplace that you wouldn’t wish on anyone.
In July 2020, I relived my sense of entrapment when I saw the various patients in the ICU. My heart went out to those kids who would probably be traumatised forever. My pathology helped me feel their predicament. My COVID ICU duty made me appreciate, probably for the first time, my neurodivergence.