'We fought back with and whatever little we were given -- little time, infrastructure, oxygen, medicines and people; and with whatever we had -- determination, common sense, experience and prayers!'
'Some of us lost our lives doing so.'
Dr Sanjeeth Peter tells us in this final part of a fascinating diary of a Covid Warrior.
- PART I: 'Most of the time I outsmart Yamaraj'
- PART II: 'Remember, Yamaraj attacks us even more when we're down'
11:30AM Two weeks later.
The bright young Dr Mehta, in charge of Covid work in the ICU, was standing next to Hemant.
She had managed several hundred Covid patients in the first wave in the Government hospital where she did her post graduation in internal medicine.
She had convinced me to resist my urge to wield the scalpel and perform a tracheostomy on Hemant until now. I walked up to her and asked if this afternoon was a good time for a tracheostomy.
'Sir, his son is coming from Australia in 3 days. Shall we wait till then?'
A major advantage of training as a cardiac surgeon in the early '90s was that we managed our own ICUs.
Cardiac Surgical ICUs were functional much before the General Surgical ICUs. And since it was a matter of the heart -- they were and still are the most advanced and best equipped -- both machines and personnel.
We had the most capable and efficient nurses, bright residents, but yet, like most cardiac surgeons, I would spend a lot of my non-operating time in the ICU, often sleeping on an empty ICU bed at night.
COVID-19 was extracting every bit of my 25 year ICU experience. We were constantly in touch with other ICU specialists, on the lookout for better modalities of treatment through others' experiences -- even for the timing of tracheostomy in Covid patients.
Every intervention was thought through and implemented keeping the best interests of the patient in mind.
Social considerations, like in this case, also contributed to decision making. I grudgingly agreed to wait for his son.
On the day his son arrived from Australia, Hemant was wide awake and seemed comfortable. His Respiratory rate was around 26, his breathing power seemed adequate, his Oxygen saturation was holding at 96 per cent and he indicated by scribbling notes that he was eager to get his endotracheal tube off.
He was weaned off the ventilator over the next day and when he spoke his first few words of gratitude, tears rolled down his face making everyone around him emotional. We realiSed that though he had been to the jaws of death and back, he was still vulnerable.
The ICU was silent except for the beeps which are its identity. It was the ICU family which fought hard. People from different skill sets, qualifications, roles and decision making powers made this moment happen.
Surprisingly, even they were near strangers to each other. They worked in different areas of the hospital. This time they were working together, shoulder to shoulder, each trusting the other's unique special abilities to see the patients through.
They handed over the patients to each other for the next shift -- sometimes with details like 'She eats better when she can see her grandchildren on a video call'.
They confided in each other -- their family situation, their small triumphs when they saw patients going home reunited with family or at times even their helplessness. They accepted each other as family now.
After all, who else would understand what they had collectively gone through?
Ironically ,it was the same day that headlines spoke of doctors being assaulted for the death of a Covid patient, of a war against 'Allopathic medicine' and people questioning the remuneration a doctor ought to get.
Now that the sirens of ambulances and wailing of helpless relatives of Covid patients flocking to overflowing hospitals has reduced, this noise gets louder. Do they realise that we have risked our lives (several even losing it) to prevent the sick from dying?
Are only the dead counted, not the living?
Aren't you alive and able to ask these questions thanks to the very same health personnel who stood bravely in front of you?
Do you realise that even we have been emotionally and mentally scarred by the mayhem left behind by the virus?
Do you realise your inane questions lead us further into an insecure hell?
When will you realise that it's not us against each other?
Shouldn't it be us against the virus?
Did you forget that we didn't just take it lying down?
We fought back with and whatever little we were given -- little time, infrastructure, oxygen, medicines and people; and with whatever we had -- determination, common sense, experience and prayers! Some of us lost our lives doing so.
Aren't we asking the wrong questions to the wrong people?
Now that we have some time to think and question; Why did all this happen?
How can we prevent this from happening again?
Waves will perhaps be back, but can we ask the right questions to ensure accountability?
Can we ensure that the next wave doesn't collapse our health infrastructure or cripple our beloved country?
And if you are wondering if at the end of the day when we are mauled and bruised not only by diseases we hope to control, but also the very patients and their relatives we aim to protect, why are we in this fight?
My friend, despite naysayers, for us, saving lives matters -- all lives! And for every empty vessel who makes this noise -- there are several more full vessels -- full of gratitude. This is what keeps us going.
But then, just because we will keep going doesn't give you the right to abuse and trash. You have a right to question and discuss - in a non-violent manner!
This is our calling and we're up to the challenge from diseases that threaten to decimate humankind.
When, for 5 consecutive days there were no new admissions to the Covid ICU, we decided to convert it back to the Cardiac ICU it was meant to be.
Holding the black Lenovo ICU tablet which we acquired for the Covid ICU that had been invaluable in connecting us to the family, I asked 'Tera kya hoga kaliya?'
Even before the others in the team who were standing around could smile, it rang out loud - an incoming WhatsApp Video call! It was Jignesh, with his characteristic broad Julia Roberts smile -- 'Just called to say Hi! Can't thank you guys enough. How are all of you?'
The Tablet continues to be in the Cardiac ICU.
Walking in the OPD corridor a few minutes later, I recognised an older gentleman leaning on his son walking in small purposeful steps.
'Kem cho Hemantbhai (How are you, Hemantbhai)?' I asked. He said he was weak, but getting better by the day. And then he said 'Tame Kaun? (Who are you?)' I wasn't in the attire he would recognise me in -- no blue gown, no cap or face shield -- only an N95 mask.
I had played my role when it was necessary, it was no longer needed for him to know who I am!
I move on to my next fight -- this time representing a 43-year-old breadwinner crippled by a malfunctioning of his heart valves as a result of a sore throat he got when he was a child.
We're going to change one valve -- use a metal mechanical one instead of the one he was created with and repair the other valve.
We would have to stop his heart, take over his circulation using a heart lung machine, delicately cut open his heart, replace the valve meticulously, repair the other valve with utmost precision, close the heart firmly but gently, restart his heart to make it beat again (after nearly 10,000 surgeries, I still get goose bumps each time this happens!) and once his heart starts beating vigorously again disconnect him from the machine.
Marvels of the Allopathic world. Thanks to the advances in science and technology he has a chance to beat Yamaraj and I'm honoured to be there fighting for him!
*Names have been changed to protect the identity of the individuals referred to in these real life experiences.
Dr Sanjeeth Peter, a cardiac surgeon with 25 years of experience in critical care, is the director and chief cardiac surgeon at the DDMM Heart Institute, Nadiad, Gujarat. He is a volunteer helping care of COVID-19 patients.
Feature Presentation: Ashish Narsale/ Rediff.com