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LETTER TO EDITOR
Ahead of print publication  

Being on the other side of the personal protective equipment


 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission19-Dec-2020
Date of Acceptance19-Dec-2020

Correspondence Address:
Pankti Mehta,
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injr.injr_348_20



How to cite this URL:
Mehta P. Being on the other side of the personal protective equipment. Indian J Rheumatol [Epub ahead of print] [cited 2021 Dec 9]. Available from: https://www.indianjrheumatol.com/preprintarticle.asp?id=326160



Dear Editor,

This is in reference to my experience of working in the COVID intensive care unit (ICU). After completing my master's in internal medicine, I'd moved on to pursue my fellowship in immunology and rheumatology. Having been away for a couple of years from critical care, I had my own apprehensions about working in the COVID ICU. Somewhere at the bottom of my heart, I also had a selfish resentment of missing out on my rheumatology training. Being the only doctor available to manage twenty patients in the ICU seemed like a daunting task, and I wondered if I would be able to manage intubations, inserting venous access lines, and the host of complications observed in these patients.

On the 1st day, I didn't realize that I was supposed to remove the film from my goggles which seriously hampered my vision and gave me a bad headache, and I was unsure about how I am going to continue working like that. But, very soon, I realized that my worries and fears were nothing compared to those being faced by the patients admitted. Medical skills are like swimming, they do come back to you even if you've been out of practice and yes, I managed to switch modes from rheumatology to critical care.

In the initial few days, I got a firsthand experience of how funny the disease indeed is. I had 35-year-olds with severe acute respiratory distress syndrome as compared to 80-year-olds who were completely asymptomatic, the latter admitted to the ICU only in apprehension of the worst. Other than the usual comorbidities, central obesity even without overt diabetes or hypertension did predispose them to severe acute respiratory illness and persistent lymphopenia was a great predictor of poor prognosis. Once patients got intubated, we felt helpless and it was difficult to wean them off support. Again, adding to the disease, there were other factors that prevented us from giving the ideal care that every intubated patient deserves, of which the sheer low doctor- and nurse-patient ratios being the most important one as having a dedicated team of nurses, physiotherapists, and attendants form the backbone of ICU care.

The most difficult part, however, is to be on the other side. Being all alone in an alien environment and knowing whether one will be able to go back home and see their kin is nothing but agonizing. We also had entire families admitted with the disease, and I can't imagine what they must be going through. I was offered bribes to get tea at odd hours for one of them and was offered the highest cash note that a patient had in return for helping him dial his son's number from his cellular phone. The anxiety they suffer from is unimaginable, and this stress could be a contributory factor in hampering clinical recovery. Seeing other patients around them to be intubated and on the ventilator also plays on their psyche. The disease itself is known to affect the mental health, and there was a sizeable number who suffered from psychosis, and attributing it to only ICU psychosis did not fit the bet.

As in most other ICUs, our treatment charts were all full of antiviral and broad-spectrum antibiotics, but it all seemed like we are shooting bullets in the wrong direction. We've learned from the past that, barring a few that are treatable, most acute viral infections require good supportive care above everything till the body fights the bugs, and looking at where we've reached as far as COVID-19 is concerned is no different.[1] In addition to this, talking to patients and relieving them of their anxiety and fear can go a long way forward. It surely can take an extra 5 min per patient, but I consider it as part of the treatment, and which is completely free of cost. I do feel if every center has some form of a facility wherein we could help them connect with their family at least once a day through a video call would be of immense help to the patients and their dear ones. Simple things such as keeping the not-so-ill patients and intubated ones in separate cubicles and promoting interaction between the set of patients in the recovery stage with those who are sick can help boost their morale.

Toward the end of my rotation, a story I'd read from the “Chicken Soup for the Soul” came back to me. It was about putting away starfish that had landed ashore back into the sea, and although there were hundreds of them lined up and all of them couldn't be possibly saved and wouldn't make a difference overall, it made a difference to the one that was being saved. And indeed, in a pandemic, we don't know how far our reach is, but we should try and give our best to whomsoever we are treating. Also, I used more tocilizumab than I've used during my rheumatology rotations, and, to be honest, my bottom line is – this virus is really beyond me!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
"Solidarity" Clinical Trial for COVID-19 Treatments. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/ g l o b a l - r e s e a r c h - o n - n o v e l - c o r o n a v i r u s - 2 0 1 9 - n c o v / solidarity-clinical-trial-for-covid-19-treatments. [Last accessed on 2020 Dec 19].  Back to cited text no. 1
    




 

 
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