In this unsettling atmosphere, I step into the uncharted territory of the coronavirus roulette. It has taken the world by a storm and everyone is affected by it — physically, emotionally and financially. As the virus proliferates in the air, fretfulness flourishes on the soil.
I was appointed to do the morning shift in the COVID ward of our respected hospital. The unit is a negative pressure area and, to us doctors, it is comforting as we embark on the Icarus flight.
“You don’t enter here without wearing personal protective equipment,” said a familiar voice. As I looked closely, I recognized him as one of the staff from the intensive care unit who I can barely identify with all of the layers he has over himself. We all look the same here.
I was assisted with putting on my goggles, shoe covers, then a headcover, followed by a N95 mask with a surgical mask over it, then gloves, and then a blue gown over my entire person. The number of layers made it hard to breathe and hard to walk.
Nevertheless, I persisted.
I rushed to see a patient who was a physician diagnosed with COVID pneumonia, desaturating but not agreeing to intubation. “If we intubate you now, it will help you,” exclaimed the anesthesiologist.
The patient replied, “I need to prolong time — I don’t think I will come back.”
This patient had most likely acquired the virus from one of his patients. Knowing the process of intubation and its associated complications, he could be anything but optimistic about the situation. However, the process of ratiocination has reached its conclusion and intubation was to be done. It took us a good two hours to get his consent, and once he made up his mind, he wanted to write down his will.
This was case number one.
The code alarm rang and we sprinted down the hall with the crash cart. CPR for 10 minutes — the patient was revived. Thankfully. This patient had returned from a religious congregation where many had been exposed to COVID-19. Now he’s here, in the intensive care unit. Even after reviving him — with his deranged blood gases and impending respiratory doom — we had to do an elective intubation. As I approached him to explain the process and its importance, he also decided to write down his will. He was intubated successfully.
Both my patients were in different rooms. Leading different lives, belonging to different sects, living in different cities. How strange that after both heard about being put on a ventilator, they acted the same.
I have been in practice for six years after graduation and have seen many patients die, for various reasons. Never have I ever come across someone asking us to wait so they can pen down their will. A will that talks about loans, return of goods, finances to distribute, things that would be worrisome for their children later.
This was thought-provoking and disturbing. It seemed like I announced death to the living.
As the day passed, there were more intubations, more deaths, more recoveries. Everything took a pause in the last hours of my shift.
I realized that the masses devour the flood of information coming to them from all directions — Facebook, WhatsApp, television, Twitter. It is haphazard, information disseminated from people who lack knowledge of the workings of medical practice. People truly believe that they will die of COVID regardless, and there is no returning from the ventilator.
We doctors know how this disease progresses. We know the prognosis for patients who need to be on a ventilator. We know that if there is a cardiac arrest during the course of COVID, the prognosis is more grim. Faced with this knowledge, we make our decisions.
I admit so far in my experience on the COVID unit that I haven’t seen many recover. It makes us doctors powerless and timid. It brings death nearer to me than it ever was before.
At the end of the shift, I talked with one of my colleagues who was with me in the day’s many ordeals. Both of us were fearful as health care workers embarking on this Icarus flight. Fear of being thrown in a battle unarmed, without protective equipment.
As people make jokes about toilet paper, panic shopping and quarantine activities. I wish I was someone rejoicing the fruits of boredom rather than standing for 12 hours straight seeing people die, uttering their last words to me instead of their loved ones.
While we are in the trenches, our communities need to stay home to prevent the spread. Even if you amplify the number of beds and ventilators, who will run the show if we get sick?
Pakistan is a developing nation with a compromised health care system — no amount of groundwork can help us deal with such a calamity. We will do our best to give hope and compassion to our patients, using our knowledge to help save them. We will utilize everything we have in this crisis to advocate for our patients, to heal them, and to share as much science and information as we can. We can only hope that things ameliorate here before they deteriorate.
Image credit: Courtesy of the author.