THE LIFE OF A COVID WARRIOR

Amyrta Saini. Senior Matron. She hated her title. Uhh… senior matron conjured the looks of a matronly person with huge haunches and a waddling walk. Amyrta was lithe and slim, did her yoga regularly and was quite pretty in, well, an Amyrta sort of way.

She took a deep breath and started her scooty for the ride back home, after a 12 hour shift at the hospital. Her back ached, her entire being felt tired. She rode home in a daze. More than anything, she was feeling sad. The sadness that had gradually become a part of her being, for the past few weeks, working at the COVID hospital, seeing death and devastation in measures that one could only imagine. Amyrta realized she was sad at all times, but today was worse. Losing the 23 year old girl after a seven day struggle had really sapped her strength. That the girl’s 19 year old brother was barely maintaining on ventilator only worsened the gloom. UK strain, they were saying, as if that lessens the misery.

Amyrta kicked off her shoes and changed out of uniform in her outer room, as had been standard for the past month. She wore her mask, as she waved out to Rajat, maintaining social distance.

“I’ll go have a bath”, she said as she rushed into the bathroom, “Gotta wash off whatever germs I’ve brought from the hospital”.

Amyrta and Rajat had been childhood friends who had grown up together. They never knew when they had actually fallen in love, but it was always known that they would marry. Now happily married for five years, they were the only thing that maintained each other’s sanity.

Rajat, an LIC agent had borne the brunt of ‘working from home’, which was an impossibility for an LIC agent. It basically meant that he had been out of work for the past one year. He had always been happy-go-lucky, and if his sitting at home affected him, he never let it show. He was always cheerful and supportive and had seamlessly moved into the stay at home husband space. He would cook and clean, so that when Amyrta came home, she would always find a hot meal waiting.

She came out of the bath feeling even more tired and lonely. She felt a deep. Insatiable desire for sharing and companionship. She could not fight it.

“Lets eat together”, she said ditching the meticulous protocol they had followed for more than a month. “I can’t go it alone today. Just feeling lonely and depressed”.

Rajat smiled as he laid the table, setting their places together, making an intimate corner on the large-ish dining table. He too missed the togetherness, but would never mention it.

“Oh! You can’t imagine how bad today was”, she started recounting her day, as she always used to, till a month ago. They sat and chatted for more than an hour, feeling the bliss of togetherness, the warm, fuzzy feeling of love washing over them.

Later, Amyrta rested her head on Rajat’s shoulder. That night, they slept in the same bed after more than a month. Amyrta kept feeling apprehensive, sort of looking over her shoulder, as if she was stealing something. Rajat typically, said nothing and enjoyed the moment. Stretched out next to him, feeling his warmth, Amyrta, for the first time in weeks, forgot the wretchedness, the misery, the death and destruction. For the first time in weeks, she felt good.

She woke up with a start two hours later.

“NOOO”, she screamed, trembling, “No, No, No, No. How could I do it?” She got and wore her mask, jumped out of bed and ran to the other room.

She was acutely aware of the fact that she was vaccinated and Rajat was not. She loved him. How could she have been so callous, so stupid, so unfeeling, so… so selfish. She felt a panic attack coming on. Normally, Rajat would have comforted her and she would have been fine. But she had to go through this alone.

‘Take deep breaths Amyrta’, she told herself, ‘it’s ok. It’s not as if you have COVID, just a higher risk’. Gradually, the trembling stopped. She couldn’t sleep. Her lights were on and Rajat tried to peep in.

“I’m sorry Rajat. Please go back to your room and try to sleep. You know we shouldn’t have done this. Heck, I am the person who tries to teach this to others. Please, please stay safe. GO.”

She got up early and did her yoga, before getting ready to leave. “You ok Rajat?” she asked, even though she knew that nothing would show in a few hours.

Her day at the hospital went in a daze. Secretly, she was happy for the work, as it didn’t allow her to think. On her way back, she bought an oximeter, and ensured that she carried a stethoscope home.

She was back to her meticulous distancing routine, at home. She bathed, changing every bit of clothing, and then double masked before she approached Rajat to give him the oximeter. “Tell me if you have any fever, bodyache, cough, however mild. Don’t skip anything.”

They ate in separate rooms, she tried to read a little as the TV was in Rajat’s room. She slept fitfully, trying to ease of some of the fatigue that had built up through the day, but was largely unsuccessful. In the twilight between sleep and wakefulness, she could only picture Rajat, lying on a hospital bed, and endotracheal tube in place, on ventilator. She knew that she was being irrational. She still couldn’t stop blaming herself. It was awful.

‘It’s not as if they hadn’t given me the choice. I could have chosen to stay at the hospital and kept Rajat safe. I, like an idiot, said I will maintain distance at home. And then I went and screwed it’. She was devastated.

Next morning was another day. ‘One day gone, nine more to go’, she said to herself, as she tried to flash a smile at Rajat, before leaving. She had decided that if Rajat stays asymptomatic for ten days, they could relax.

Rajat, normally one of the most relaxed guys around, was also feeling a little jumpy, mostly due to Amyrta’s nervousness. He started feeling a little irritation at the back of his throat. Or perhaps he was imagining it. He couldn’t say.

Sitting at home and doing nothing, his mind constantly kept playing the sore throat scenario. ‘It’s nothing’, he told himself, ‘I don’t think I’ll bother Amyrta with this”.

“Two over, eight more to go”, Amyrta chirped as she breezed in. It had been a good day at the hospital. The oxygen problem had sorted itself out. None of the serious patients had deteriorated. There had been no deaths. Amyrta was feeling as good as she had felt lately. She, of course, assumed that Rajat was well.

Rajat had kept quiet about his niggling sore throat. He had served her dinner on a plate and kept it outside her room, which she had picked up and they had stayed separate.

Day three was largely unremarkable. Rajat wasn’t sure whether his sore throat had stayed the same or not. Amyrta had a good day, the second in a row.

Amyrta had a really bad day on day four. Two deaths, arguments with relatives, other patients jostling for beds even before the dead bodies were out. As the senior matron, she was doing crowd control as much as she was doing medical and nursing work. She was tired by the time she reached home. She also had a splitting headache. Rajat, on the other hand had had a good day. His sore throat had become better. He had slept the entire day, had exercised for an hour and had cooked a nice meal. Amyrta ate and slept, too tired to taste the food.  

The next day was even worse for Amyrta. She had woken up with a headache. The ward was bad. Fighting for patients’ lives, the deaths in the ward, crowd control, running between wards, shortage of oxygen, shortage of Remdesivir and obnoxious relatives. By the time she reached home she was dead tired, had a splitting headache. Rajat had mentioned something about a sore throat as he had given her food. She had dismissed it without thinking.

Day Six. It hit her as she woke up with a splitting headache. She also had a mild fever. Then she remembered. Rajat had mentioned a sore throat. Could it be? No. No, it can’t be. She got up, did her yoga and pranayama, double masked and asked Rajat how he was feeling. He had a sore throat and was sleeping a lot. No fever. He had measured his SpO2 which was normal. No he did not have fever. Amyrta omitted telling him that she had fever.

Her day was a replica of the previous two days, tough and tiring, with no break. Her fever and headache had not helped. By the time she reached home, her fever was more than 100 deg. Rajat was better. Mild headache and fever. He felt it may just be anxiety.

The next day Amyrta woke up with high fever. She could not even think of going for work. She called in sick. Rajat had some fever, cough. Both of them measured their SpO2, which was ok. They went to the hospital for a RAT test which was negative. They asked for an RTPCR. The result would take two days.

“Dr Peerzada, it’s about my husband”, she had approached the head of the COVID facility. “He’s running fever, maybe I could have infected him. We’re maintaining social distancing at home, but one never knows”, she lied. “Could we reserve a bed for him?”

Dr Peerzada had been kind and his soothing voice had allayed some of her anxiety. She promised to show Rajat to him the next day.

The next two days were also bad, but better. Amyrta’s fever subsided over the next day. Rajat improved as Amyrta stayed home and his anxiety settled. Staying in the same house, albeit in separate rooms had a calming affect on their anxieties. Their fever and cough subsided. They smiled a smile of togetherness.

 

Author’s Note: This story attempts to bring out the kind of anxiety and difficulties families of medical and nursing personnel go through. This is over and above the difficult situations they face at work. Please think about it.

 

 

Ash

“The BP is dropping, we should start inotropes”, was the breathless interjection from the treating physician.

“SpO2 levels are also dropping, seemed ok some time ago”.

The patient, a senior citizen of great importance did not look good. He appeared a little listless, a little confused and frankly very ill. He is much liked, very popular and has done only good to people. Everyone is concerned.

They confer privately. “We need to get him to a better equipped centre… That is the only hope”.

“But it is a four hour journey. Will he be able to undertake it?”

“What is the other option? We’ll send a doctor along with him. It’s eight in the morning, if we start early enough, he will be at the hospital by noon. That’s not too bad”.

And so the decision is taken. We’ll send him with adequate oxygen, IV fluids, medicines and a doctor. The front section of the ambulance would be sealed, so that the driver stays safe. Air-conditioning will cause air circulation, and endanger the driver, so it will be switched off. The windows will remain open for cross-ventilation. The doctor would be exposed to COVID from the patient.

Ash was the natural choice. He is a doctor already suffering from COVID, though mostly asymptomatic, some mild cough, fever, bodyache. Nothing that cannot be handled.

Nothing, except of course, Murphy and his laws. The transfer kept getting delayed, hour after hour. First it was stabilizing the patient, then the paper-work, then ensuring adequate oxygen then adequate fluids and so on… By the time they finally started, it was 01:30 pm. The outside temperature had climbed to 42 deg Celsius. The patient was not as well compensated as he was in the morning. Ash, was hot and with the dehydration COVID brings in, thirsty. His fever had increased and he was not feeling too well.

Ash kept it together, though. Irrespective of his personal discomfort, he maintained hemodynamic stability, maintained oxygen levels, kept the patient’s fever under check, made sure he remained lucid.

On the other hand, Ash himself was hot, thirsty, badly feverish and had severe bodyache. He held on steadfast.

The final leg to the hospital was a little more torrid. The patient’s BP started dropping a little and oxygen saturation suffered. Ash made the necessary adjustments. They reached safely. Phew… what a relief.

After the patient reached the ICU, Ash finally breathed. He spoke to the DMO, “I need a room for 15 min or so”.

Inside the room, he disregarded the fever, the bodyache, the dehydration, the awfully sick feeling. He folded his pant cuffs, washed his hands and feet and turned west.

“Bismillah, in the name of Allah the most merciful, the benevolent”. He prayed, and had his first sip of water since sunrise, as he opened his Roza fast.

 

 

that’s really good news

Lila and Tibs… The silent bastions on whom it all has been resting for the past month. Ever since the second wave broke, they have been at it. Day in and day out, sleeping, living, eating, breathing COVID.

Lila is the elder one… by some one year or so, and would never let Tibs forget that. Tibs is a little younger, considers himself a little stronger. She is bubbly, charming, enthusiastic, easy to smile and vivacious. Tibs on the other hand is the silent, quiet type. They are both efficient, knowledgeable, concerned and above all caring.

They are the two doctors at the Station Medicare Centre (SMC), at an Air Force Station, somewhere in the heartland. There are others, but one has got COVID, while the other was, well, out for some time. So just Lila and Tibs. Usually, its not that tough. Oh, they do have a clientele of 8000 or so, but they manage. What tipped the balance was April.

In the month of April, the SMC has had 230 cases of COVID, positive on Rapid Antigen Test (RAT). This means that there would be another 1000 lurking around here and there, some asymptomatic, some scared to come over lest they are quarantined, some missed by the RAT, whatever. But 230 is a lot.

Lila is newly married, her naval officer (Sudhir) posted far away. She could barely squeeze in a honeymoon before the China virus played spoilsport. Tibs managed a brief trip to his steady girl and came back with COVID a few months back. Hasn’t managed to meet her since. They still remain cheerful.

So let’s see what it means, looking after 230 COVID patients, by two doctors. 15 min to 30 min of questions by relatives for 230 patients… CHECK. Getting basic protocol tests ie Blood counts, Renal Function, Liver function for 230 people, regularly, sifting through results, ensuring you don’t miss anything… CHECK. Monitoring SpO2 levels for 230 patients four times a day, keeping track, making sure none are missed… CHECK. Rechecking after a six minute walk test… that’s eight times a day… CHECK.

Then the first person starts showing a little low SpO2 and the next struggle starts. The overloaded local hospital’s first reaction is, we can’t. You manage. Give oxygen in the SMC. So then that is a sudden huge demand on the limited number of people available. But they manage. Running from patient to patient, attending some meetings on hygiene or sanitation or sewage or water, all the time worried about the patient on an oxygen concentrator at the SMC.

Lila develops a cough. Fever is 102 deg. She has been double masking, hand sanitizing, social distancing, covering herself. But she knew this was coming… someday, somehow. She walks up to Tibs, to find him coughing, bodyache, fever is 100 deg. They sit down. Now what? What happens to the 230? They sit silent for two hours. Drink nimbu-paani after nimbu-pani, trying to figure out what to do. Obviously, there is no logical answer. If they see patients, they could be super-spreaders. If they don’t, who does?

Lila resolves. Pops two tablets of Paracetamol, asks Tibs to go home and relax. She stays, does her work. Her RAT test is negative. She will get an RT-PCR tomorrow. She wades through the day. It was horrible, high fever, outside temperature 42 deg Celsius, cough, bodyache.

The next day both Lila and Tibs undergo an RT PCR. Buzzed with Paracetamol, wade into the day, like they have over the past month. Fever varies between 99 and 102 deg for both. The bodyache is killing. The cough is bad. Exhausted they go back home.

Lila is in bed hugging Sudhir’s photograph, waiting for sleep to come. Tibs calls… RTPCR results came back. It is NOT COVID. It is just exhaustion, he says.

Oh… that’s really good news, she says. She hugs Sudhir’s photographs tighter and goes to sleep.

 

Lona’s Ordeal

It started simply enough. I had been double vaccinated, second dose on the 18^th of Feb and felt confident. A cough and fever started on 9^th Apr, so I quietly told the wife that I will shift to the next room, just in case. You see, she was not yet immunized.

12^th Apr was Monday, and got a RAT test, which was positive. Sangeeta and Tintin remained negative. The fever subsided by the 13^th as did the cough. Sangeeta tested positive on the 14^th, so I managed to get back into the bedroom, with the attendant Netflix and so on… Settled in for a ‘break’. Maze karenge.

The fever recurred by the 15^th, as did the cough. Felt it was time to get an x-ray done, which was absolutely fine. However, still decided to get a CT and inflammatory markers done. CT showed 7/25 involvement, bilaterally. Inflammatory markers were marginal. Spoke to the medical specialist who advised admission. Was admitted on 17^th Apr to the local hospital.

At the time of admission, I was running 102-103 deg fever, severe cough. SpO2 was maintained. Was placed in a far-flung ward with a medical assistant peeping in twice a day to check SpO2 and BP. Getting a cup of tea took 48 h and water 6 h. The nurse would come once in two days. The Med Spl would pop in daily and have a conversation. Over the next two days, my appetite disappeared, and I remained nil orally for the next 48 h. The fever was unrelenting and though my SpO2 appeared to be holding, the cough was awful. I didn’t realize it then, but I was getting slightly breathless going to the loo and was avoiding it. I would brush, but find it difficult to rinse my mouth, breathlessness. The hospital stay was yielding little, other than sapping my spirits and giving me an occasional paracetamol. So when the Med Spl suggested discharge on 20^th Apr, I jumped at it. This, even though I was running fever now for ten days, had cough, breathlessness, and according to Sangeeta, was barely coherent… Dull, listless and sort of oblivious of surroundings.

After reaching home, the fever, cough and breathlessness persisted. Since I could now monitor and assess myself, I realized that even slight activity was causing my SpO2 to drop to 88-89, though it would recover spontaneously. That is when Sangeeta took charge and rang up my brother, a Gen Surgeon but dealing with a lot of COVID cases as any other general practitioner in India. He was categorical… Start injectable steroids and Injectable LMWH, IMMEDIATELY.

Well, took the first dose of steroids and found that within the next six hours, my fever of almost ten days relented. Inflammatory markers sent the next day had gone through the roof. I got an oxygen concentrator home and settled in to brave the Cytokine storm at home, having lost faith in the hospital completely. Every day was an improvement, as it was a challenge. It took two days for the appetite to come back, the cough still persists. The inflammatory markers settled within the next three days. Netflix (sadly absent at the hospital) aided an early recovery, even though news channels tried their best to dampen the spirits.

To cut a long story short, today is the eighth day on injectable steroids and LMWH. My SpO2 levels are holding. Did a half hour walk today without losing SpO2. I feel that the worst is over, though one can never say for sure. It has been an ordeal like few others and is testimony to the healing power of love and affection of loved ones as much as it is that of medicines. Saved by my wife and brother as much as by modern medicine. Phew….

The Desi Traveler

I suppose travelers from all countries have a distinct sort of identity, some peculiarities, which identify them to others, more specifically their own countrymen. Over years, I have found that the Americans would find everyone other than an American inefficient, rude, unhelpful and generally nuts. Europeans, and I shall differentiate between different countries in Europe at some other time, find others uncouth, uncultured, flashy and so on...

So what about the Desi Traveler? For my readers from outside India, Desi is a part endearing, part pejorative term for a person of Indian origin - stemming perhaps from the fact that Columbus  and his cronies usurped the term Indian for the original inhabitants of the New World, leaving us kind of identity-less, till we found Desi. 'Desi' (देसी) comes from 'desh' (देश) meaning country, and literally means a country person, or a country bumpkin.