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Monday, June 21, 2021

One day in a Covid ICU

The Sunday Express brings stories and photographs from seven hours spent at Holy Family, one of the hospitals at the heart of Delhi’s coronavirus crisis.

Written by Amil Bhatnagar |
Updated: May 9, 2021 7:53:58 am
In Room No. 4 of the ICU. As a policy, Holy Family has decided not to turn away any patient, and adding beds, between two regular beds, the ICU now has 60 patients instead of the usual 48. (Express Photo)

The beds between beds, the prayers for two pregnant women, the cheer from a video call, the nurses sustaining on juice, the doctor with a Netflix story, the files in polythene bags, the long hours of wait, the despair over oxygen, and the 14-year-old who came off a ventilator. The Sunday Express brings stories and photographs from seven hours spent at Holy Family, one of the hospitals at the heart of Delhi’s coronavirus crisis.

It is 10 am in South East Delhi’s Holy Family Hospital and Dr Sumit Ray arrives in ICU Room No. 4. Donning a blue PPE gown, the doctor greets a staff of nurses whose shift began two hours earlier. There is a short discussion, before the staff begin their monitoring of the 60 beds in the hospital’s Covid ICU — located on the other side of two wooden doors with steel panels.

Inside is a distinct world. Gone is the commotion of the hospital, replaced by the sound of muted, shuffling feet, dragging of metal wheels, and beeping of monitors.

The doctor takes a slow round, stopping at beds occasionally to flip through patient’s chart sheets. Most of the patients are unconscious because of heavy medication. There is a narrow passage of about 4 feet between the two rows of beds on either side.

On any given day, the ICU would have 48 beds and Dr Ray would be able to spend seven-eight minutes with a patient. The surge of cases and the hospital’s decision to not refuse any has resulted in capacity expansion.

On two adjacent beds in Room No. 4 of the ICU lie two 32-week-old pregnant women. Nurses have been rooting for them, their babies. (Express Photo)

“The most important trend we have observed in this wave is the surge of cases. If perhaps there were fewer patients, we would be in a position to give even better care and time. I can only spend three-four minutes with each,” says Ray, Head of Department, Critical Care Medicine, and Medical Superintendent.

Apart from Room 4, the Covid ICU has another, wider room, with beds placed there too to fill all possible space.

The hospital has 49 ventilators in total, all of which are in use, and is using six anaesthesia machines for temporary ventilation. Authorities say orders have been placed for more ventilators but deliveries are delayed.

With its capacity of 390 ‘adult’ beds, Holy Family was declared a 100% Covid facility in the first week of April. Since then, the hospital has seen 1,600 admissions and more than 190 deaths. Half of those deaths were on arrival in the Emergency and not in the hospital wards or ICUs.

At 10.30 am, five staff members clad in PPE gather around a 70-year-old on a ventilator in Room 4. With a countdown, the patient is lifted onto a moveable stretcher, and taken for trachea treatment. Not much later, a patient on an adjacent ICU bed takes his place on the ventilator after his oxygen levels drop partially.

There is very little conversation among the resident doctors, nurses and interns. Like clockwork, the staff move from bed to bed, administering medicines, checking vitals, and taking notes, watching out for any little deterioration that may cost a life, not sitting down for more than a few seconds at a time. Two members are continuously at work at a small station, updating patient data in computers.

Still on his rounds, Ray meanwhile leans in to have a conversation with a 35-year-old patient who has a nozzle attached for High Flow Nasal Oxygen supply. To ease his discomfort, the doctor throws in a reference to the Netflix show Peaky Blinders. The patient smiles briefly and goes back to lying in a foetal position in an attempt to breathe better.

“There is a significant rise in the number of young patients in the critical ward,” Ray says. “Even though many of them recover well, the worry remains.”

At one end of the room, a small curtain is pulled aside and two staff members emerge and head to a washbasin to clean their hands vigorously. Another staff member pulls out a stretcher from behind the curtains revealing a body covered in white sheet. The patient, in his 50s, had been admitted for more than four days. He died a couple of hours earlier, the staff say, and his body was being prepared for the mortuary, which includes removing the wires and monitors keeping track of his vitals. As two interns enter his final data into a computer, the area is sanitised to receive another patient.

Explained

Capital mess

With an average of 19,000 cases per day, Delhi has been battered hard in the second coronavirus wave — seeing among the most cases in the country, and crossing own peak of daily deaths. Hospital facilities like Holy Family have come under tremendous strain, with the government struggling to streamline operations. More than 30 deaths have been attributed to shortage of oxygen alone. Only now, with the intervention of courts, is the oxygen situation stabilising and doctors made available for tele-consultation to ease some load of hospitals.

Which patient will get an ICU bed is a complex decision based on many factors, says Ray. “An entire team sits down and discusses the next admission. It could be based on age, condition etc. Sometimes we are called at 4 am to take a decision. There is no guarantee that a person already in the hospital will get it.”

As the stretcher with the body is manoeuvred out, a nurse rolls in a portable X-ray machine between two beds. One of the beds, a makeshift one, is at a lower height. Two women, aged 27 and 29, are on the adjacent beds. Strangers, they have one thing in common — both are 32 weeks pregnant. The nursing staff have been silently praying that the women and their unborn children stay safe.

In the second wave, while hospitals have seen several cases of pregnant women, none has so far had complications.

Ray says the situation has demanded a lot of their dedicated staff, who have been working months without a break. Founded in 1953 by Medical Mission Sisters, Holy Family was subsequently handed over to the Delhi Catholic Archdiocese, and currently Rev Anil J T Couto, the Archbishop of Delhi, is the Chairman of the hospital’s governing body. Ray has been in the profession for 31 years, and served in senior posts at several hospitals.

“Our nurses are very empathetic, they speak from the heart and look out for patients on a personal level… The entire staff is rooting for the two expectant mothers,” says the Medical Superintendent.

On the left of Room 4, a gallery leads to another portion of the ICU. Down a narrow corridor are two small rooms with their doors ajar. Inside, a couple of nurses are quickly gulping down juice packets in their brief break.

Extra beds being placed in the ICU corridor. (Express Photo)

Given the rise in cases, the nursing staff shifts have been changed from three eight-hour shifts to two 12-hour ones. The nurses wear multiple layers of masks, as well as gloves and PPE gowns at all times. There is no time to eat during shifts.

A majority of them stay on the campus in accommodation provided by the hospital. A cot is placed in a small room for those who want to stretch legs briefly.

Around 12.30 pm in the second room of the ICU, at a bed placed near the door, the monitor of a patient suddenly starts beeping. Six people rush to his side. The man is unconscious. Observing that his oxygen is dropping, the team lifts him and puts him onto the prone position (on his stomach) to improve his breathing.

At a bed placed diagonally, a 51-year-old is sitting holding his head in his hand, occasionally sipping water from a bottle. He looks exhausted, struggling for every breath, and finally even the bottle dangles from his hand. A nurse notices his condition and walks over and hands him a phone tablet. Soon the screen lights up to show his family members.

“You do not worry. We are all fine here. You just take care of yourself,” says his brother on the video call. “Do you know we had to get rid of the smartphone? So many people called for you that the touch screen couldn’t handle it. This is how popular you are,” adds the brother. The 51-year-old smiles wearily, smoothes down his hair and gives a thumbs-up.

The nurse says they have given family members the phone number of the ICU, and provided a tablet to the patients, since unlike non-Covid ICU, no visitors are allowed here. “We let family members make one or two calls a day. It keeps their spirits up.”

As the clock approaches lunchtime, a multi-layered trolley is wheeled in with juice and hot beverages. The stress is on a nutrition-rich diet to help patients sustain the intensive treatment. Most patients can only take liquid food. Some resist eating due to the lack of taste and smell and appetite, as well as discomfort. The nurses try their best to convince them to eat.

Outside the ICU, a crowd has begun to gather. Since visits are not allowed, the family members have come to try meet doctors for an update. They are barred beyond the first level of ICU entry, but many stay hours, sitting on stairs or the floor, even at this distance. Every time the door swings open, they jump to their feet in anticipation. All eyes follow the medical staff going in and out.

On the ground floor, in the Emergency section, a different scene is playing out. Most of the arriving patients have spent some time in home isolation, and come when need arises for oxygen support. The hospital staff has been instructed to not refuse anyone unless the capacity is exhausted. Oxygen is administered to almost everyone, even if for a short period.

A patient on video call with family members. Families are allowed 1-2 calls a day, and the tablet has been provided by the hospital. (Express Photo)

Right next to the entrance, a man and woman have been hooked onto the central oxygen supply. The man, lying on a narrow stretcher, is being fanned by his brother. “My brother was having breathing issues. We were lucky we found a place in the Emergency in two hours,” says Virendra Saini, 33.

They are now waiting for a bed. “If the hospital tells us it is vacant, we will get him admitted,” he says.

Nearby, Tushar Kumar, a pharmacist, says he has already lost his grandfather and mother-in-law to Covid within days. Now, after four days of hunting for hospitals, he has managed a stretcher for his father in the Emergency.

“We have been to so many places and it is finally here that we found some space. For now, he needs oxygen supply and the hospital says they can manage it,” says Kumar.

On other days, the front section of the Emergency, next to the registration counter, serves as a waiting area. With patients placed in chairs and stretchers, it is now literally a mini-ward.

From a nurse station inside the main Covid ward in the Emergency area, announcements are made on mics regarding doctors and patients. A room for gynaecologists and a minor operation theatre have also been turned into Covid wards. In a small room, patients can be seen sitting next to each other sharing oxygen.

Several makeshift arrangements have been made to accommodate as many people as possible, with beds separated by less than a foot. There is no mandatory testing for attendants, and they are here at own risk.

On a bed placed right in front of the washroom, a son is rubbing his mother’s back to ease her breathing. The area demarcated for supplies and stacked with shelves of medicines also has a bed along with a cylinder. Another bed has been placed at the end of the corridor, leaving just enough space for a door to open.

Apart from the beds, patients occupy chairs — 15 steel ones are placed haphazardly in the centre of the ward, equipped with oxygen. While some patients are receiving oxygen from the LMO (Liquid Medical Oxygen) central line, some others breathe from a D-type cylinder, with a capacity of 40-60 litres. Some patients have come with their own supplies.

A 70-year-old sits on a stool next to her son on a stretcher, wiping her tears every five minutes. Another pleads with the nurse to keep a watch over her husband as she fetches food for the two of them. Two young brothers frantically search for attendants to fix their father’s mask to the cylinder as it comes off.

Medical Superintendent Dr Ray on his rounds. (Express Photo)

Outnumbered by the patients, the staff often break into a sprint to keep pace.

In another corner, two siblings keep urging a staff member to admit their father, as he tells them it is subject to someone getting discharged. “Where will my father go if there is no bed here? We do not have oxygen at home either,” they say, clutching a polythene bag full of reports, before finally walking back to their father to consider their options.

The chaos in the Emergency Room is not audible in the office of the Medical Superintendent, where another crisis is playing out. Dr Ray has just received news that eight patients have died at Batra Hospital, located not too far away, following lack of oxygen.

As the day wears on towards evening, Dr Ray says this is their constant worry. “Every day we are on the edge when it comes to oxygen supply. The trucks we send out for cylinders have a waiting period of 24 hours. We have enough LMO but the demand is unprecedented. This needs to be resolved.”

Over the sound of another ambulance siren, the Medical Superintendent says, “The fact remains that top leaders went into a celebratory mood announcing the end of corona… Even now many states are hiding information… So much needs to be done for the hospitals and doctors to help patients.”

And that’s all they ask. “The nurses, staff are working night and day… The last thing we want is to be betrayed by oxygen,” says Dr Ray, as he begins making calls to the logistics team to prepare for the night.

However, in the midst of the gloom, there is hope as well. While there is little time to celebrate recoveries, each person who goes home well is a prayer answered, Dr Ray says. “We have 40 beds for children, and had a 14-year-old on a ventilator. But nothing happened to him. After a few days, he was back to his normal health, and returned home… Not all is lost.”

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