COVID-19 and the ICU: Conquering Fear on the Frontline!
Over the past two months, the world has seen a relentless surge in the coronavirus disease 2019 (COVID-19) cases.
WHO declared Europe to be the epicentre on March 13, and the pandemic has changed centres ever since, from Italy surpassing China to Iran, Spain, United Kingdom and as of last month, the United States has seen the most surge in COVID-19 cases, heralding an unprecedented wave of fatalities that this century has ever witnessed. Not only that, but Pakistan also recorded the highest number of deaths in 24 hours on May 30.
With 6,057,853 confirmed cases globally and over 50,000 deaths in more than 200 countries, 2020 is no less than a year of the apocalypse as one may call it. Not to mention the 370,000 plus deaths worldwide.
With nearly 76,000 confirmed cases in Pakistan, a number that has grown manifold over the last few weeks, is a matter of grave concern for both the government and the common man.
While we are awash with these harrowing statistics, being a pediatric intensivist in a country less than a fifty trained intensivists and just over 2000 ventilators for a 200 plus million population has turned our world upside down. And there comes the Intensive Care, commonly known as the ICU, us, our staff and physicians putting their lives at risk every single day to save lives.
How does it feel to work as an ICU physician amidst this crisis? The answer is one word: Privilege!
As a Pediatric ICU physician, though I may be amongst the fortunate ones to have seen COVID-19 positive children with mild and occasionally moderate symptoms, I am prepared at all times to help my fellow adult ICU colleagues whenever the need arises.
We, the ICU physicians are precious: rare commodities who have been trained to run and play with the ventilators; We work on the frontlines of the corona pandemic. But having said that, even though have been trained to work under crises, we are not immune to the universal fear that has woven us all together.
Given the fact that we still lack enough testing kits to cater to our population, every patient may be a potential source of the virus –regardless of their complaint – and I may be one of the many asymptomatic carriers. More so with the temporary ease in lockdown that has unfortunately made us surpass the West in terms of numbers, our people need to realize that COVID-19 very much Exists! Ask the son whose father got intubated and they are not able to see each other or the pregnant mom who has gotten hypoxic, her lungs for craving for oxygen to save her unborn; What more evidence will be evidence enough? I ask myself and wonder if there will ever be any right answer to that.
Never was the worth of Personal Protective Equipment (PPE) realized in its essence before this greatest threat to global health known in history. Before this pandemic, I would dispose of my mask after seeing a patient; With the dearth of available PPE, am cognizant of the fact that the same mask needs to be worn as long as it lasts. My PPE and hand sanitizer are my biggest armour in these times of lockdown, a once draconian phenomenon when it started to almost a routine now for all.
Every effort is made to maintain hand hygiene and “not-touch-one’s face” as they say it; ask an ICU doc and one would know how difficult it is!
There’s a constant fear of testing positive one day and what happens next? Isolation for two weeks if all remains well; and here we are talking of a nation, that already has a handful of intensivists and imagine as more colleagues test positive, what happens when there is no one left to work, or my own thermometer alarms? And as more and more patients require ventilators, how does one decide who gets and who does not? To add some flavor to this existing holocaust for a critical care physician, our basic mask wearing compliance is “unapologetically” pathetic, with masks “all over the face”, be it then hanging by the ear, over the chin (will not delve into this further; you all know better).
COVID-19 has impacted everyone: that too to a catastrophic extent. These are times of despair; but it is these times that has made us realize what strength it is to have each other as our support systems.
Constant battle with uncertainty and paranoia and lack of correct public awareness are amongst the many ramifications of this ‘novelty’. Wearing the N-95 for an indefinite period, intubating all “suspected COVID-19” patients with the fear of “what if they are positive and I have been exposed during the aerosol-generating procedure?”, putting in central lines, exposure to family members of COVID positive patients during the counselling session, breaking out the news of the ‘positive corona test’ to them.
Never have I been prouder of being a critical care physician; there’s much more meaning to what we are doing right now and life in the trenches seems to be far superior than resigning to barracks. There’s a renewed sense of purpose and the fears that existed initially while managing COVID-19 positive patients have turned to the “bring-it-on” mode.
As I enter my patient’s room, I remember three things: my purpose as a Muslim, a doctor and a member of our society.
All three of these roles call me to provide service to others, and this purpose overcomes all my fears. Metaphors aside, this is a war worth fighting. Like you all, we didn’t want this, but we’re ready, willing and able.
Humans were created to connect with one another. Some of my most powerful moments as an ICU physician haven’t revolved around a flashy procedure or a cutting-edge diagnosis. Instead, they have been the times I have shared with my patients; my critically ill pediatric patients. My Islamic faith teaches me to do no harm and to love your neighbour as yourself.
Hence, we know not to respond to fear with anxiety but instead with faith and sincere hope.
As Fanucci beautifully points out, this battle is to regain the simple pleasures of life, rather than for any medals or glory. It is about becoming a better version of ourselves. There are many lessons to be learned, so let’s take this time of relative shutdown to listen hard. Life always has something to teach, and the offer of a cup of tea is always a good idea and the same holds true for life in the ICU.
While we all grieve the times, it is these times that have renewed a new spirit of connectedness; We health-care workers are fortunate enough to relearn that human contact is beautiful, that caring for others matters, and that finding humour in every day is amazing. My ICU is a microcosm of our society; we are a diverse set of brilliant individuals who are continually brought together by the crisis to serve those in need. Each of us is important, be it then our housekeeping staff, a technician or a nurse. A patient’s life is saved only through our collective, harmonized efforts and dedicated teamwork.
As fear and anxiety continue to permeate the society, we physicians need to respond with hope and vigor and not succumb to our fears and anxiety.
We signed up for this deal, our very own “Hippocratic Oath” to serve years ago. These times have only brought us closer and united us with a purpose to heal the world.
Stories of physicians being saluted and paid accolades are the ones to celebrate beyond the existing chaos. Let’s collect stories every day. And mind you, this too shall pass and it is these stories that we shall be telling our children and grandchildren.
Bring it on! We are here to help you and each other. Let’s fight this together!