‘I’m in my PPE, nobody can see me cry…’: Kerala ICU docs bridge gulf of Covid trauma, loneliness

“Njan marichu enna vichariche (I thought I had died),” stated Nasarullah over the telephone in a matter-of-fact approach.
On September 11 final 12 months, Nasarullah, a 50-year-old persistent kidney affected person settled in Mandya district of Karnataka, was rushed in an ambulance to the Pariyaram Govt Medical College Hospital (MCH) in Kerala’s Kannur district after he was contaminated with coronavirus. The oxygen degree in his blood had plummeted and it was more and more clear that the virus had began taking maintain of his lungs and different organs. His spouse, Fathima, additionally examined optimistic, however barring a fever, she had no main problems.
“For 17 days, he remained in a critical condition in the ICU. Doctors told me to pray because all his indicators were high. He had pneumonia, high blood pressure, chronic diabetes with his kidneys badly damaged,” stated Fathima, who spent the time lodged in a room within the Ayurvedic block of the medical school whose solely window opened out to a forest on the again.

“My daughter also had Covid and she was being looked after by a family friend. It was a really testing time for us,” she stated.
After three weeks of intensive remedy, Nasarullah’s pneumonia was cured and his blood sugar ranges introduced again beneath management. Once he turned secure, he was transferred to the ward the place he was joined by his spouse.
Nasarullah, 50, who spent 17 days in a vital situation within the Covid ICU on the Pariyaram Govt Medical College Hospital in Kannur, and his spouse Fathima. Both of them survived the an infection.
“All that I remember in the ICU is someone brushing my teeth in the morning and feeding me upma. Most of the time, I was unconscious,” he recalled. “If I am alive today, it’s all thanks to medical superintendent Dr K Sudeep and the team of doctors and nurses at the hospital. I got the best treatment I could have ever hoped for,” he stated.
And that affection lingers even immediately. Since their return house, Fathima begins her day by sending morning message on WhatsApp to Dr Sudeep, a person she has by no means even met.
“Dr Sudeep gave us a new life, a re-birth. If we hadn’t come to Kannur, my husband wouldn’t be alive. I’m very sure of that. I will always be grateful to him and all the health staff there. I don’t know their names, but I will always remember them,” added Fathima.
But the place there are tales of hope similar to this, there are additionally anecdotes of grief and loss.
June 6, 2020 is a date that Dr Shinas Babu will maybe always remember in life. That day, the Manjeri Govt Medical College Hospital (MCH), the place Dr Babu serves because the Covid-19 nodal officer, recorded its first casualty of the virus: 61-year-old Hamza Koya, a veteran footballer who performed for Maharashtra within the Santosh Trophy within the 80s.
In May, Koya, alongside along with his household, had travelled to his hometown in Kerala from Mumbai, contracting the an infection within the course of. His spouse and son have been the primary to check optimistic, adopted by him, his daughter-in-law and grandchildren. But whereas they didn’t develop severe signs, he was introduced into the ICU as his situation deteriorated quick.
“We did everything we could, including plasma therapy. But we lost him,” stated Dr Babu.

Before the final rites, Koya’s household, additionally admitted to the identical hospital as a result of Covid-19, expressed a want to see his physique. But as per protocol, entry to the ICU is granted solely to seriously-ill sufferers and healthcare employees.
To honour their want, Dr Babu had an concept.
“I put on the PPE, inserted my phone in a transparent cover and stepped into the ICU. I went near Koya’s body and I video-called his son Lihas on WhatsApp to show them the body. They asked me if I could hover the phone over his face so that they could blow a kiss. It was very, very traumatic. They were all crying on the phone and somewhere I broke down too because there was nothing else we could do,” recalled Dr Babu, calling it one of the vital painful moments of his life.
Across ICUs on the planet, the previous 12 months and even now, such episodes are enjoying out, providing a profound view of how healthcare staff are straining to do their jobs and on the identical time bridge the gulf between Covid-patients and their family members. The ICU, even with all its superior contraptions to maintain life, has been a really lonely place the previous 12 months. For many, it’s these well being staff in full-body PPE gear, unidentified by title and unrecognisable by gender, who stay at their aspect at their most weak — brushing their tooth, feeding them and taking out their waste. And typically, if their luck runs out, they’re additionally the final individuals they see in life.
An ‘unpredictable’ virus
Even as the remainder of India, with the potential exception of Maharashtra, have dialled down infections significantly, Kerala, as soon as hailed for its efforts towards the virus within the preliminary stage of the pandemic, continues to report a weekly common of over 6000 instances. That means, hospitals, particularly the tertiary care services, within the state are nonetheless overwhelmed and well being staff teetering on the sting. Officials declare the conduct of the native physique elections in December and a normal decline of alertness among the many public are seen to have spiked instances once more.
Though the case fatality charge of Kerala (0.4%) continues to be among the many lowest within the nation, each day deaths have oscillated between 10 and 30 for the final six months. Nearly 75% of the deceased have been above the age of 60.
The key to saving the lifetime of a seriously-ill Covid affected person, stated Dr Fathahudheen, Covid-19 nodal officer on the Ernakulam Govt Medical College Hospital (MCH), is to deliver them in, early within the illness course of. “If you get the patient in the right window period early in the disease process, they really improve and come out well. But if the patient comes in late into the ICU with severe deficiency of oxygen and injury to other organs, whatever you do, there’s no response in the patient,” he stated.

“The factor that determines the outcome is the interaction between the virus and the body’s host immune response. If the immune response is balanced and you get early treatment, you may come out of it (illness). Some people’s immune response is highly irritable and when it’s dysregulated, it goes for an overdrive leading to a cytokine storm, and resulting in death.”
When indianexpress.com referred to as Dr Fathahudheen in April final 12 months, he was beaming in regards to the profitable restoration of a 57-year-old British vacationer from Covid-19 on the hospital. His crew on the Ernakulam MCH had efficiently used HIV antiretroviral medication to beat again the virus regardless of the affected person’s severe comorbidities. But since then, as instances soared and the an infection slipped into the group, deaths turned unavoidable.
Dr Fathahudeen (from left) with Dr Ganesh and Dr Jacob Ok Jacob with British nationwide Brian Lockwood who was handled for 17 days in a Covid ICU and recovered efficiently on the Govt Medical College Hospital in Ernakulam in April 2020.
Dr Fathahudheen stated, “It was heartbreaking to see many, especially young patients, dying before our eyes despite making all possible interventions. It’s when science turns helpless and you become a mute spectator before this highly contagious virus.”
In reality, in a number of conversations with docs serving within the Covid ICUs, the ‘unpredictability’ of the virus and its propensity to wreak havoc within the respiratory system at a fast tempo has at all times stood out. Doctors stated they have been baffled to see sufferers, even younger ones who look completely happy and cheerful within the morning properly on their street to restoration, instantly growing a cardiac arrest and dying inside the subsequent hour. Or as instances of ‘happy hypoxia’ the place blood oxygen ranges come down, resulting in shortness of breath and shutdown of organs.
For the bystanders and family members, such sudden deaths are extremely laborious to course of and typically, it’s the well being employees bearing the brunt of it.
“It created a sort of medical agony for us to talk to them and convince them that this is how this disease behaves. And so, we always tell families of patients admitted to the ICU that the outcome of this disease is unpredictable. And until and unless, the patient’s oxygen levels become normal and until they are able to breathe normally without oxygen support, we cannot say they are in a safe zone,” stated Dr Fathahudheen.
Dr Jacob Ok Jacob, inner medication professor on the Ernakulam MCH, stated he’s typically felt that the general public are usually not in a position to perceive the seriousness of the work that goes on contained in the Covid wards and ICUs. That it’s a fierce battle between life and loss of life, and plenty of instances, even the perfect of skilled docs can’t predict which approach it might tilt.
“We are dealing with a highly misunderstood population. They are looking at it through a consumerist lens. But having said that, it has not deterred us in any way to go back on our duties… some of these deaths leave an imprint on us and we feel a sense of inadequacy. That, even with all our armoury, we feel that ultimately it’s not in our hands,” he added.
In such a context, communication turns into a pivotal facet of Covid-19 administration, each with sufferers in addition to their bystanders. There is an obligation to calm their nerves, and on the identical time, inform them of the urgency of the state of affairs.
Dr Shimna Azeez, who has had a whole lot of interactions with Covid-19 sufferers and their households whereas working within the OP division on the Manjeri Govt Medical College Hospital.
Dr Shimna Azeez has manned the Covid outpatient division on the Manjeri Govt MCH for practically ten months, conversing with a whole lot of individuals who got here in with suspected signs and their households. She’s additionally a author and an influential voice on Facebook, serving to to decode complicated well being points for the layman.
“Any disease which mandates physical distance between a patient and his family is a tragedy. So, just like my father and mother are important for me, for somebody else, their parents are important too. When it comes to Covid, I have never tried to console people. I have always informed and educated them with facts and pointed out the risk factors. Otherwise, it may backfire because we don’t know when this patient’s condition may deteriorate. Giving false hope is also unethical,” stated Dr Azeez.
One of the affirmative initiatives of the Manjeri Govt MCH, early on within the pandemic, was making a WhatsApp group of individuals who recovered from Covid to be able to foster a way of togetherness. Through the group, docs suggested them on post-Covid restoration and dispelled doubts in regards to the virus. It was additionally used to encourage them to donate plasma for the remedy of these in vital situation. The state’s first plasma financial institution was additionally arrange on the hospital.
The loneliness of the illness
For many healthcare employees, the previous 12 months of the pandemic has taught classes they may have by no means discovered in medical college. They have seen deaths, and lives being reclaimed, at shut quarters. They have heard innumerable tales of struggling and trauma, of feeling remoted and uncared for. Families and buddies torn aside by a virus. To an extent, that at some degree, their work stopped being only a job, however a bigger a part of a faculty consciousness.
Dr Jacob stated, “One of the things I understood quite clearly in the last one year was the meaning of life, especially when I interact with patients and their families. People are propelled by money and ego in life. But once inside that ICU, there’s no ego or money. Patients bid goodbye to their families and they come with just a bag of clothes.”
He continued, “I have seen many people, in their 70s and 80s, who are such a beloved part of their families. Inside the ICU, they seem so helpless and alone. Sometimes, when we get a feeling that a patient may not last long, I hold their hands to make them at peace. They clasp my hands tightly to their chest. They need that touch and there’s no one else to do it at the time. I have even broken down into tears, talking to them. But since I’m in my PPE, no one can see me crying.”

Similarly, Dr Azeez spoke of receiving a name from a person from UAE sooner or later, complaining of toothache. She contacted her buddies there and arrange an appointment for him to satisfy a dentist. “And then, I asked him if he had any food to eat. He just started crying. He said he didn’t have any food and that he was planning to pluck moringa leaves from a neighbouring compound, boil it and eat it. I froze,” she stated, including that she organized to get him provisions for one month via her community.
“In the last year, the definition of being human was made clear to me. Every patient was a story…”
For Sheena KP, a employees nurse within the an infection management crew on the Kozhikode Govt Medical College Hospital, the pandemic’s worst results are usually not utterly new. For she was a vital a part of the crew on the hospital that fought the Nipah virus in 2018 which claimed the lives of 18 individuals. And a 12 months later, when Nipah returned to the state via a affected person in Ernakulam district, Sheena was on the forefront of coaching different nurses in an infection management.
“In 2018, all of us at Kozhikode had performed duties wearing PPE at a time when no one knew what a PPE was. Our parents had warned us, but we couldn’t stay away… we know the risks of infection, but we still do it because this is our profession. It was a huge learning experience,” she stated.
But not like Nipah, which was short-lived albeit with a excessive mortality charge, the Covid-19 pandemic continues to be very a lot right here, a 12 months later, leaving nurses like Sheena exhausted.
“Then and now, health workers are working round-the-clock. We are not going on vacations or shopping for clothes. Everything’s been put on the backburner. Today, our bodies have adjusted to the PPE. Everyone among the nurses here has lost weight. We have skin-care problems and urinary tract infections,” she stated.

With that in thoughts, I requested her if the pandemic and its bodily and emotional struggles ever prompted a rethink of her career.
She paused for some time after which replied, “It’s not that I wanted to be a nurse. I wanted to be a teacher. But my family didn’t have a strong financial standing to put me through a graduate degree and higher education. A family friend, who was a nurse, saw my high marks in school and advised me to become a nurse.”
“I do this job because I like it. The thing about this job is that we are with a person when they are at their most vulnerable. There’s nothing more debilitating than getting an illness.”