A COVID- I C(are) U(nit)

A COVID- I C(are) U(nit)

‘Why would you do that to me? Why would you shift me to another ward?’, complained Keshav, a patient who was admitted in our COVID ICU. He required oxygen at levels where he could be shifted to another ward and so we did as per our protocol. ‘No one talks to me there’ was his complaint. Despite getting the same treatment as he was getting in our ICU he was dissatisfied. He wanted to talk to people, share a joke with them and receive a smile from everyone taking care of him the way it was happening for about 10 days in the ICU.

This was not a one-off incident in our 20 bedded ICU where we worked during the second peak of the COVID-19 pandemic located inside a district hospital which also functions as a medical college in our case. Our team of 17 nurses and 12 doctors started work in mid May in what was called the ‘New ICU’. All the patients we cared for had different degrees and complexities of COVID related illnesses. Most of them have oxygen saturation levels at dangerously low levels, many had different organs like kidney, brain and heart involved in a way that threatened their life and hence needed critical care support. Surguja, a district which lies in the northern part of Chhattisgarh has only limited health care resources. With the arrival of the pandemic, the acute need became a desperate calling from the district administration which led to our team of doctors (3 of us who are specialists in different fields and prior ICU experience) volunteering in the facility. Before we knew it, this offer of providing services in a n ICU came our way by getting a team of doctors and nurses to work along with us. This was the largest ICU facility in the division comprising 5 districts and hence got patients who were referred in desperate situations. We cared for close to 100 patients out of which 35 succumbed to their illness. The patients spent around 7 days with us on an average in the ICU with some patients spending a few hours while others spending more than a month recuperating from a debilitating bout of COVID-19.

Almost all our staff (barring the three of us who were volunteering) had no experience of working in an intensive care unit. A training of 2 hours, an informal chat listening to them, their concerns  and experiences and initial hand holding as everyone got used to their roles and responsibilities in the first one week of our work was all it took to set the ball rolling. What followed was a rollercoaster worth remembering. Getting things done in a government set up is difficult on any day, when the situation is as desperate as it was, it needs a certain mindset called, ‘whatever it takes’. The mandate for all our staff was simple- ‘do whatever it takes to ensure things are done/arranged in the best interest of your patients’. It needed tact, clear and honest communication, being strict and stern at occasions and being argumentative in the middle of the night at certain other times to get the job done. The job to be done varied- getting a medicine or an equipment which was not available till yesterday because of administrative reasons, getting a blood test done in time, starting a new service like dialysis for patients with COVID-19 in our district, getting the right diet for our patients or anything that the patient wished to eat through personal expenses before being discharged. Everyone suffered their share of struggles and resistance in the early part of our journey. Administratively it was a task to convince everyone from the hospital administrators to fellow doctors from medical college and nursing staff about what is the appropriate Personal protective gear in a COVID ICU. What we (our team in ICU) were using as protective gear was considered (by the rest of the government staff) to be risky and fraught with danger. One month into the ICU and we could slowly see everyone wearing the same gear. Patient files were considered an infectious source and hence were not taken inside the ICU for the fear of spreading infection. With time both science and sensibility prevailed and the resistance turned into lessons for everyone and fear gave way to mutual respect and camaraderie.

Each patient came to the ICU with their set of vital parameters like pulse rate, oxygen levels, blood pressure etc. More importantly each one of them had their own unique story. As we spent more time with our patients and got used to taking care of their vitals, their life stories became equally vital for everyone in the team. The relationship was of love and care for the individual and his/her family. Knowing and addressing each other with their names was a routine. Sharing concerns both medical and at times personal was part of our work. Instructing the patients never came before listening and helping them. What started off as random requests to take bribes but please take better care of us soon became either loads of blessings, discussing family matters, joking around and at times getting offended if someone did not smile while working in the ICU. ‘You care for us like you are family’ was the commonest thing we heard during our shifts.

Ours was a unique ICU in one special way. Relatives and family members were allowed to be with the patients. This uniqueness was a result of lack of sufficient staff members/nursing orderlies available to be posted in the ICU and thus was an unsaid rule not mandated administratively but pragmatically. We had only two such staff available in each shift and that too irregularly. The relatives were thus active caregivers along with our team. That many of them were there was an ethical dilemma for us considering the high chances of getting infected themselves. There were however some intended and unintended benefits. Patients and family members felt reassured and patients got the much needed emotional support in desperate times. They became active supporters of our care and participated in it keeping the best interest in mind. As they spent more time in the ICU, got used to the functioning and caring for their patients in a government run hospital, they became counselors and supporters for the new patients coming in the ICU. They helped fellow travelers (friends and families of the newly arrived patients) about how to submit money or avail insurance in the hospital, how to submit a requisition form for an X-ray and where to rest and get food and other supplies. They would also listen to each other and help each other’s patients. A patient who spent more than 50 days with us in the ICU had the perfect arrangements after a few days. His wife would make Khichdi for everyone in the ICU who needed it (both patients and their relatives) and everyone prayed for each other.

In the ICU we realize that many times, ’why we die’ may not be in our hands especially in a place where we were with only limited resources available. However even in these places the ‘how we die’ part of death is still something we can do about. Deaths need not be painful and distressing for the patient. The life of all our patients was important to us. That death in certain situations is inevitable wasn’t something we were unaware of. ‘How they die’ was an active part of our discussions before and during our work. Suffering can be helped even if death is inevitable. We thus focused on addressing suffering at all times. It meant making specific arrangements for getting some drugs and equipment for certain patients, getting a table fan arranged for another patient, arranging for a video call with a close relative or allowing a prayer to be done over the phone in certain scenarios.

As time went by and the number of patients getting discharged surpassed new admissions, many of them needed follow -up support. All patients got our phone numbers at discharge and a phone call asking about their well being, family and any other concern. The patients usually called to show their gratitude, send their blessings and sometimes to send a delicacy prepared at home they promised that they will send once they reach home. The cure for people admitted in ICUs can be long, tortuous and difficult. The care for them is within reach of everyone looking after them. Many patients and their relatives had this to share at one point of their illness or the other,’ what we had heard in COVID hospitals was that no one comes and checks on us, no one would come near us. You however did not hesitate to get in contact when needed, were always available for my care as if this was not a COVID hospital’.

– Chetanya Malik

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