|Year : 2022 | Volume
| Issue : 2 | Page : 196-197
A chunk of coal
Department of Psychiatry, INHS Asvini, Mumbai, Maharashtra, India
|Date of Submission||19-Apr-2022|
|Date of Decision||11-May-2022|
|Date of Acceptance||17-May-2022|
|Date of Web Publication||19-Aug-2022|
Dr. Shradha Khatri
Department of Psychiatry, INHS Asvini, Mumbai - 400 005, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: In December 2019, an outbreak of pneumonia of unknown origin was reported in Wuhan, Hubei Province, China and the World Health Organization declared it as a pandemic on 12 March 2020. The pandemic had devastating repercussions in form of human lives, economy and mental health. Method: This article brings in light the experiences, expectations and coping mechanisms of the author during raging 30-days duty in a 250 bedded isolated Covid-19 pneumonia ward. Results: While the world stagnated in the walls of their residence, the health care workers, donning the badge of “Duty to serve”, faced a real-time war against the pandemic with sidelines of stigma, discrimination and mental trauma, in their stride with their heads held high. Conclusions: The article focuses on helpless, frustrating yet intriguing journey through the experiences encountered in midst of the second wave of the pandemic, ending with a sense of humility, gratitude, resilience and post-traumatic growth.
Keywords: COVID-19, posttraumatic growth, resilience
|How to cite this article:|
Khatri S. A chunk of coal. Ann Indian Psychiatry 2022;6:196-7
April 18, 2021, “not-a-usual” Sunday. I am at a tertiary hospital in Mumbai in the midst of the second wave of COVID-19 in India. The night before, I stay back with a colleague after she received a call, “Everyone at home has tested positive, Papa's SpO2 is dropping to 80%.” The night was spent desperately seeking leads for a hospital with the availability of bed and Oxygen, in Delhi for her Dad. We eat cereal in silence, listening to Yellow by Coldplay. Later, she gets back to harbinger of agony calls from home, and I go to review my Psychiatry in-patients.
While returning, I get a call to commence COVID-19 ward duty from the next day. I have a strange rush of emotions, a sense of dread. Colleague's Papa further deteriorates, and she decides to go home – “What is the point of being a doctor anyway if I can't be there with my family in a health crisis?”
The next morning, I reach the isolated COVID-19 ward complex and orient to the management protocol. Initially, I deal with noncritical patients, constantly worried about keeping myself uninfected. As the wave peaks, mortality spikes. Sense of panic is palpable among patients, and a strange helplessness creeps inside me. Families are admitted across the wards, a husband in the intensive care unit, his wife in a high dependency unit (HDU), while their son refuses to leave the waiting area – how does he go to an empty home? Patients struggle with noninvasive ventilation (NIV) and non-rebreathable masks (NRBMs), their armors, which come with extreme suffocation. Some patients suffer hypoxic injuries and develop delirium-persecutory delusions against us; allegedly injecting them with “poisonous chemicals” and making them breathe “toxic gases.”
A part of my day is spent reassuring families of patients on phone. I try maintaining an empathetic demeanor but still can't resist sarcasm when answering why ventilator is necessary, and “Pranayam” can't be a substitute for Oxygen. There are frustrating moments too when I yell, “your husband dies if instead of caring for him, I update you every hour.”
Breaking bad news and soft skills are my forte as a Psychiatry resident, but it had been a while since I declared someone's death. I find myself in a cold sweat while preparing a death certificate. As I gently disclose the news to a son, I can sense his heart sinking, as if a world is uprooting. I retire to my lounge in tears, I have failed a son, I have failed a father. My medicine colleague rushes in with the news of another death in HDU. I can see my helplessness mirroring in his eyes. We take turns to express our angst, and gradually the situation seems less helpless, a realization that we are doing everything in our capacity. I remain awake an extra hour that night, with the son's cries floating in and out of my conscience.
The next day, I see a familiar face behind a mask being wheeled into HDU. Soon nurse approaches, asking about Ekbom syndrome, and requests to prescribe the antipsychotic patient is taking. It is then I recognize the face as one of my out-patients. Her saturation continues to decline and she succumbs to pneumonia in 2 days. The loss feels personal when I break the news to her daughter.
Subsequent weeks had patients deteriorating, and dying, and my sense of defeat demonizing while breaking the bad news. Me and my colleagues make it a point to ventilate our emotions, all the while desperately trying to pull another life that hangs in the balance, to change their inevitable end. We do not give up, not yet.
Mrs. A, admitted with mild pneumonia, deteriorates suddenly, is wheeled into HDU and is placed on NIV. Saturation declines, she suffers hypoxic injury and becomes delirious, which challenges her care, her NIV compliance, and prognosis. She looks like a scared puppy lost in the medical wilderness. The nursing team takes utmost care, feeding her with straw, and preventing pressure sores. On day 5, she is oriented and reciprocates. She does not resist the NIV and often smiles when we hold her hand for assurance. Slowly, she is weaned off from NIV to NRBM to face mask, and the next week she is able to maintain adequate saturation at room air. We have won one battle among the many losing ones.
Another section of the ward continues to be flooded with noncritical patients with comorbidities – a renal failure patient prepped for renal transplantation after 5 years of dialysis, mercury poisoning with progressive dermatomyopathy, patients with fractures and cancers mandating surgical interventions, all incidentally being tested COVID-19 positive.
I am introduced to a world that I had only hitherto witnessed from the side-lines of Psychiatry. While my friends from other specialties crib about not getting their hands on scalpels during the pandemic, I am overloaded! For every panicking COVID-19 patient, there are families needing reassurance, grief counseling, and support to deal with survivor guilt.
Gradually, as we catch the nerve of the pandemic, recovery rate improves. Patients accusing us of persecuting them now apologize and thank us during discharge. Most of the families of the deceased too are grateful to us for taking care of their loved ones till their last breath. I use my skills to prepare the families of the deceased for the likely stages of grief as they do not participate in the last rites (due to pandemic restrictions), thus complicating their grieving.
The end of my rotation comes with a sense of mainly relief, along with gratitude, accomplishment, and in hindsight, even some resilience and “posttraumatic growth,” likely facilitated by sharing overwhelming emotions with my colleagues, focusing on what was in my control and support from hospital administration, empathetic to our needs.
On the last day of my rotation, I walk out feeling a little shinier – after all, “a diamond is just a chunk of coal that did well under pressure!”
The author would like to thank Dr. Seby Kuruthukulangara, MBBS, MD, Ph.D. (Neuro-Psychiatry) HOD and Senior Advisor, Psychiatry, INHS Asvini, Mumbai, Maharashtra, India.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Olson K, Shanafelt T, Southwick S. Pandemic-driven posttraumatic growth for organizations and individuals. JAMA 2020;324:1829-30.