When Viny Kantroo, a respiratory diseases specialist, started seeing COVID-19 patients in a Delhi hospital, a whole new world unfolded in front of her – both personally and professionally. “It has never been so tough before, taking care of your own breathlessness and that of your patients’, simultaneously”, she says in this guest post.
My heart skips a beat thinking of Thursday. That’s the day my scheduled week-long duty starts in COVID-19 wards and intensive care units (ICU) every fortnight.
The rotation means constantly staying awake, or rather alert, even when you close your eyes in the ward to catch a few winks. The phone generally rings the moment you are transitioning from stage 1 to stage 2 of what we call, in medical parlance, non-rapid eye movement (NREM) sleep. The mind works constantly with the adrenaline rush that comes with attending to patients with COVID-19. I have not mastered the art of calming down despite years of being in crunch situations.
On one such day in the second week of April 2020, I had to get to my hospital late in the evening to insert a chest tube in a COVID-19 patient with collapsed lungs (pneumothorax). I have never had such cold feet, even when I learnt this for the very first time. I was worried about hurting the patient and creating complications because of limited vision resulting from elaborate eye gears of my personal protective equipment (PPE), but more overwhelming was the fact that I was in the middle of a contagion, dealing with a disease with no proven treatment. Suddenly, I felt like a student again.
At the back of my mind, I was also constantly battling the burden of carrying infection home. When on COVID-19 duty, I cover myself up, or rather my fear, with an extra layer of surgical mask above my N-95 mask. This actually hampers my breathing. I start panting for breath while speaking, but at least my mind stays calm and focused on patients. It is not easy to experience strained breath. It triggers a vicious cycle inside the brain. This experience has actually given me the empathy to feel what my non-COVID asthma and Chronic Obstructive Pulmonary Disease (COPD) patients feel when they come short of breath every winter.
Coming back to that late evening scene in the COVID-19 ward – I stood there mustering all my courage, my hands trembling as I punched in the code to open the ICU door. The smell in there is peculiar, different from outside these areas. This smell always has a strong relationship with emotions – it sets a chain reaction inside my imaginary world – that the air is full of virus but I have to make way to the donning room and preferably not touch the door handles or the door itself.
This comes naturally to me though. My parents taught me the science of fomites and their importance well before I studied medicine. I would wash hands after touching public lift buttons, electrical switches, door handles and staircase railings even in normal times. This has made me a villain at home many times and I have been labelled as having an obsessive compulsive disorder of sorts, but I have made this practice very clear to both family and friends. So while my colleagues are still coming to terms with the changed reality, I am way more confident of navigating through doors and handles. Also, getting ready within 15 to 20 minutes without exposing any part of your skin is a mental rather than a physical task. It requires sealing the gaps between eye sockets and visors.
I could feel a pronounced silence as I entered the patient area that evening. I had to be in very close contact with the patient. This was more than the normal daily ICU rounds. All I could see were the dark corners and a foggy tunneled central vision. This was partly the physical reality, partly the constant fogging of my visors and mostly psychological. I instantly thought of music. I had brought in a bluetooth speaker the previous day with me to leave in the ICU for everyone.
I inserted the chest tube in about 25 minutes, way beyond what it normally takes. The extra layers above my coveralls made me sweat profusely. I desperately wanted some air. I saw the other patients and tidied out their medication, checked ventilators and asked my staff if there was anything else I could do for them (not that I was more capable than them but sometimes asking makes all the difference). I left the area for the designated doffing region and slowly removed the body suit and layers in 15 minutes to avoid creating aerosols.
Each time I came out of the ICU after attending to patients, I felt a strange sense of relief. Whether this is because I helped somebody or whether I could breathe better, I don’t know. But I surely have started to value the small little things in life much more than I ever did in the past. One thing which remains universal among healthcare workers across the globe is everyone wants to ‘breathe’. Everyone is just tired of the FFP 1, 2, 3s and N-95s. It has never been so tough before, taking care of your own breathlessness and that of your patients’, simultaneously.
For my mental health, I feel COVID-19 has done more good than bad though. I no longer run constantly, struggling with road traffic or my own mind’s traffic. I have a clear sense of priorities now. My time management has improved and I am now ready to start my third week of COVID-19 rotation today. I strategically plan my weeks ahead so that I am able to spend some time with my family – be it ‘happy wedding anniversary’ moments or saying a virtual hello to my family members around the world during my weeks off COVID-19 patient areas.
I had elaborate plans for 2020, as I was away from my family for the last two years pursuing academic interests in London. I am content, however, that I manage to be around my small world – with my husband, who is also a doctor, and a four-year old son.
On the upside, I recorded a song in my voice after many years. This has been a very big boost as I had lost the capacity to sing when I lost my first child some years back. My voice had choked and I had accepted that this was permanent. I now understand nothing is permanent in this world, not even grief. I see things with more optimism now waiting for a time when I can take a long breath in the mountains with my feet in the river water underneath.
[Viny Kantroo is a Respiratory, Critical Care & Sleep Medicine specialist at Indraprastha Apollo Hospitals, New Delhi, India.]