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Friday, June 25, 2021

The day the music died: Farewells in a Covid ward

It’s a practice that most doctors have perfected over the past year — a straight face, a steady voice — even as we watch family members crumble with grief, scream and shout.


Updated: May 16, 2021 8:25:00 am
Dr Ghosh and her colleagues. “The emotional burden of failing patients is going to take a massive toll. Hope in the long run, our efforts matter,” she says

Written by Dr Dipshikha Ghosh

Sanghamitra Chatterjee came to the hospital on May 6. It was a ‘severe’ Covid-19 case, and we got to work immediately, putting her on high-dose steroids, nebulisations, prophylactic antibiotics, among other medications.

There is a shortage of everything now but our situation is not as bad as government hospitals. However, there are times when we have to triage to decide who gets medication and ventilators first. In Sanghamitra’s case, we were quite aggressive with our approach to the disease. During our rounds, my colleagues and I would discuss her condition with seniors, who would then plan on future treatment.

Unfortunately, her condition started deteriorating fast and she had to be put on non-invasive ventilation — a frightening process for many patients. The tight-fitting mask clings to the area around the nose and mouth, often leaving cuts on the bridge of the nose and marks on cheeks. Many patients keep taking the mask off, sometimes squeezing their fingers into the mask to find relief from the discomfort. Sanghamitra didn’t complain.

For over a year now, I have stood beside beds, counselling patients as they are put through this difficult treatment. Many talk about their families, some find comfort in discussing trivial matters, a few try to size up the healthcare worker behind the coverall, the stranger who has been by their side in the most vulnerable phase of their life. “You have beautiful eyes,” a patient told me once — the only part of me visible to her through the impenetrable PPE. In the ICU, where the Covid-19 patients I see are among the sickest of the sick, such conversations are routine. The patients know little about their caregivers, other than their voice or eyes.

Covid-19 patients don’t crash immediately. The deterioration is fast, but it happens over a few days, and many times one sees death approaching stealthily. The treatment gets more intense in severe cases, and at least 10 times a day I go from bed to bed counselling patients to stay motivated. There are no attendants allowed and our connection becomes quite intimate. For patients who are not conscious, our job is to treat them with dignity. We fix their gowns if they are out of place, we lift their arm if it has fallen over the edge of the bed. These small gestures matter.

As the first wave hit the country last year, our hospital started the practice of making video calls to families of patients. We showed them the vitals of their loved ones on the monitor, the oxygen supply to the bed, the medicines they were being given. At a time of immense uncertainty, it was the only way we could assure anguished families.

Later, the same calls began to serve another purpose — to convey last messages and wishes. A son told us to keep a birthday cake next to his unconscious, intubated parent, knowing well that he would never be able to eat it. Another told us to keep a ‘get well soon Daadu’ card that his son had made for his grandfather inside the bag that would be used to pack his father’s body.

To put it simply, being on Covid-19 duty in the last year has felt horrible. During the first wave, I did my duty fearlessly, following protocols to keep my family safe. But a year of staying on a separate floor, eating in my room, talking over video calls or yelling while maintaining a distance of over 12 feet, have taken a toll. This time, as I see younger patients collapse day after day, I am not just scared for my family, I’m scared for myself.

With many such thoughts on my mind, as I signed in for my shift at 8 am on May 12 and met Sanghamitra, I knew she didn’t have more than 24 hours left. Her oxygen levels had plummeted and she was now being sustained on 100 per cent external oxygen. By 3 pm, it was time for that video call. As I held the phone close to her, her 25-year-old son Soham hummed Tera mujhse hai pehle ka naata koi, breaking down several times.

There were many moist eyes in the ward that afternoon.

I just stood there, silently. It’s a practice that most doctors have perfected over the past year — a straight face, a steady voice — even as we watch family members crumble with grief, scream and shout. Some try to vehemently deny the reality, others stare into the screen, trying to capture the last moments of their loved ones for life. In such moments, doctors can say nothing. We just have to be there.

Exactly 12 hours after that call, Sanghamitra breathed her last. She was only 48. Like many of our patients, she had many more years left in her, but the virus cut her journey short. For us, the emotional farewell by Soham and the fact that we lost another life added to our pain.

For healthcare workers across the world, the experience of these long, gruelling shifts in thick polyester PPEs, daily encounters with grief, and the emotional burden of failing patients is going to take a massive toll in the near future. I hope in the long run, our efforts matter.

Dr Ghosh works in the Covid ICU at Apollo Hospital in Kolkata
As told to Ankita Dwivedi Johri

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