BANGALORE/NEW DELHI – Last week in Rajkot, a small town in Gujarat, a local newspaper devoted eight of its 20 pages to the obituaries of 285 who died of Covid-19.
“Three of them were my patients,” said Dr Vivek Jivani, an intensivist in a private hospital in Rajkot, one of the worst affected towns in the pandemic’s second wave. To endure the powerlessness and anxiety, he makes time for at least a 10-minute prayer every morning.
“People are dying because of circumstances I cannot control, but still, every time a patient dies on my watch, I tell myself, try harder for the next person,” said Dr Jivani, 30, during his so-called lunch break when he was responding to missed calls especially from patients’ loved ones.
Treating Covid-19 patients as if on a life marathon, doctors and nurses across India are trying to be islands of calm: precise, organised and lucid in the midst of pandemonium.
When The Straits Times spoke to medical professionals across the country witnessing and working through the devastating second wave of Covid-19, the words that came up repeatedly were: overwhelmed, angry, sleepy, hungry, burnt out, afraid, numb, helpless and – most of all – tired.
Dr Jalil Parkar, a pulmonologist in Lilavati Hospital in Mumbai said that unlike during the first wave, doctors were now familiar with the nature of Covid-19. This time, however, “the humongous volume, the mutations, the sheer speed of deterioration in a breathless patient, the tremendous fear all around, and our own limited resources are killing us”.
He referred to this second wave as “World War II” – deadlier and even more preventable than the first.
When infections plateaued in December, politicians, citizens and medical professionals relaxed. Masks and social distancing abandoned, crowds thronged political rallies, month-long religious festivals and lavish weddings. These “covidiots” set the coronavirus rampaging throughout the country, Dr Parkar said.
India now records more than 347,000 new infections every day. Its creaking healthcare system is on its knees. Over 2,500 people are dying every day.
The national capital Delhi is the worst affected, registering 24,331 cases and 348 deaths on Friday (April 23). Sick people and their relatives are scrambling for hospital beds and life-saving drugs.
At Indraprastha Apollo Hospital in Delhi, Dr S. Chatterjee, an internal medicine physician, said he is physically and mentally exhausted.
Dr Chatterjee, 56, works an average of 18 hours a day. He has 90 Covid-19 patients under his care and scores of others on video consultation, leaving little time for sleep or meals.
Four hours is the most he has slept in 10 days.
“Delhi has the best infrastructure possible. To think Delhi can be going through this is unbelievable,” Dr Chatterjee said.
“The phone calls (from known patients) don’t stop. I was one of those doctors answering all calls. (But) if I pick up the calls, I end up seeing no patient properly. It is really agonising. Quite a few patients must be thinking this doctor has changed so much and is not helping us,” he added.
For a week now, Rajkot’s Dr Jivani too has been inundated with “200 to 300 calls a day” about bed availability or where to get remdesivir, an anti-viral drug used to treat critical Covid-19 patients that is so scarce now that it is selling for six times its price on the black market.
During the first wave, healthcare workers worried about contracting the coronavirus, but this time, they struggle to provide the best treatment under unprecedented challenges.
Given depleting oxygen reserves, Dr Rajendra Prasad, a neuro and spine surgeon at Indraprastha Apollo Hospital in Delhi, said doctors face the impossible choice of deciding which critical patient is more in need of oxygen.
“Which are the cases to prioritise? Who is critical and who is bad? These are not situations we have ever faced in our careers,” he said.
He is one of the many specialists and surgeons in the country today who have had to quickly master the multidisciplinary approach that a pandemic demands.
Even those who have been in actual war-like situations feel unprepared. Dr Reshma Tewari, the head of critical care at Artemis hospital in Gurgaon, who worked in an army hospital in 1999, when India fought Pakistan in Kashmir, said:
“A lot of casualties came in at that time… Now every hospital is in the same (war-like) situation.”
Every morning, she and other doctors have an oxygen audit to ensure enough supply.
With 30 years of experience, “I’m not someone who gets depressed easily. But I am feeling low. I can fight on one front, but it is difficult to fight on two fronts,” she added.
More patients now show symptoms of breathlessness and rapidly falling oxygen saturation than in the first wave, said experts. Faced with a tidal wave, most hospitals are only admitting those with severe symptoms and comorbidities, and sending the others home. Still, space is tight.
“We have lost all sense of proportion and balance, having to turn down patients we know are critically ill, and won’t make it without access to a hospital,” said Dr Vivek Shenoy, an intensivist in Bangalore’s Rajshekhar Hospital.
His institute only has 25 critical care beds, and each patient stayed for an average of 10 days. “There is just no turnover of beds,” he said.
“Most doctors are not used to seeing four or ten patients die everyday,” said Mumbai-based emergency medicine specialist Dr Murtuza Ghiya. A member of the Indian Medical Association’s committee for emotional well being of doctors and medical students, he noted that the pandemic had intensified burnout, alcoholism and smoking among medical professionals.
Thrown into a Covid-19 ward as soon as he passed his postgraduate exams, a 26-year-old doctor in Chennai, who did not want to be named, said he had been prepared for the medical and equipment challenges, but not the political ones.
The administrative head of his hospital had instructed all the staff to admit people with acute respiratory distress but no Covid-19 tests to the non-Covid wards to “show fewer Covid deaths”.
“If a patient dies of bronchial pneumonia or respiratory failure, ideally we have to consider them as Covid deaths, but this is not being done,” said the disillusioned Chennai doctor.
The son of a state-run transport technician, the first-generation graduate admitted to also struggling with financial obligations.
“Postgraduate doctors in Tamil Nadu are getting paid a pittance of 35,000 rupees (S$620), half that of neighbouring states. They told us they’ll double it, but they haven’t. Nurses are getting 20,000 rupees, and the cleaning staff who do so much of the riskiest grunt work are getting 6000,” he said.
The Chennai doctor had applied for the 200,000 rupees ex-gratia the Indian government promised to “Corona warriors” who were infected with Covid-19, but like hundreds across the country, he is yet to get any money.
“I feel so disrespected, but I still come with energy to work because it’s not the sick people’s fault,” he said.
In the eastern city of Kolkata in West Bengal, Dr Kunal Sarkar, senior vice chairman, director and head of cardiac surgery at Medica Super Speciality Hospital, said his staff had to handle climbing infections in the backdrop of politicians holding crowded public meetings in a multi-phase state election.
“It’s not often that you feel like a five-and-a-half-foot person standing off a 100-foot wave,” said Dr Sarkar.
Most doctors said they did not share their anxieties or fears with their family, to protect them. In many ways, Covid safety protocols had left them as isolated as the patients they were treating.
Dr Shakti V (not her real name), a general medicine doctor in one of Chennai’s biggest state hospitals, had spent weeks away from her husband and two-year-old son when an elderly couple was admitted in the Covid-19 block. The wife, 65, was in the critical care unit and the husband, 70, in the regular Covid ward.
“Every day when I went on my rounds, the old man would beg to see his wife. We don’t usually allow anyone into Covid ICUs, but I got permission and took him in a wheelchair to the ICU window. He would watch her for a few hours everyday. One day, when she got worse, he broke down, saying she was his only family.”
The story seemed to be moving towards a tragic end, but the couple recovered. They even blessed Dr Shakti’s team as their “children from god”.
For Dr Shakti, it was a miracle that gave her hope amid interminable trauma.