By Dr. George Jacob
Kochi, July 5, 2020: It’s 4:26 pm. I am at my appointed station in the cold environs of the ICU I work in. Right over my head is the AC blower. It almost draws a parallel between my not-so-comfortable situation and that of a dressed broiler chicken tucked away in the recesses of a deep freezer of a meat store!
The pitter-patter of the first rains of the year’s Southwest monsoon outside adds to the shivers. But, keeping me on tenterhooks, and having my brain housed inside my artificially-created bald pate occupied is the patient to my left. He had come to the hospital to undergo colonoscopy (endoscopy of the large bowel).
Unfortunately, hyponatraemia-low sodium levels had him throw a seizure followed by cardiac arrest. As part of resuscitation he has been connected to the ventilator. Having suffered a stroke years back, this man’s brain is already on the back foot. He is yet to wake up despite cessation of sedation. It looks like it might take some more time.
But, fears of the cardiac arrest having caused more damage to his brain, already compromised by the stroke weigh heavily on his treating team, which includes me. He must wake up somehow. We couldn’t afford a patient who had walked in for an investigation to end up in a coma. More days on the ventilator could have him undergo tracheostomy (a procedure that places a tube into the trachea) to help doctors wean him of the ventilator.
But tracheostomy is too high a price, and an unfair one to pay for a person who had come for a colonoscopy. It would have been ideal if tracheostomy is avoided. A stroke survivor myself, I was familiar with nuances of brain damage. The uncertainties. The real and glaring possibilities of disabilities that the patient might have to contend with.
It is next afternoon. Here I am in the same ICU. On the same chair. The same AC blower spits cold air onto my same bald pate. The patient hasn’t made much headway. His children were briefed about the lack of any improvement to talk about, and the need for a tracheostomy. The next day, the man was tracheostomized. A price to pay. Imperative, yet seemingly unfair.
But tracheostomy, which his doctors hoped he would do without will do him a lot of good in terms of weaning him of the ventilator. Medical science sometimes might seem a tad unfair. But then, nothing is done to harm the sick by custodians of that science, who only wish those placed under their care makes it. Always!
Just as I was letting the disappointment that instantly shrouded his children’s faces on being told about the decision to go ahead with tracheostomy sink in, my attention was taken captive by a recorded message played through the hospital’s public address system. The message reminded patients, staff and attendants within the hospital to maintain social distancing to limit transmission of the virus-SARS CoV-2 that had taken the world, including the tiny Indian state of Kerala where I reside hostage since January 2020.
The word ‘Covid’, the pandemic caused by the virus from China has become an integral part on televisions, in newspapers and conversations. It was at its worst in the social media, which spread lies, hearsay, claims and rumors. Most of them plain canard. It is true Covid had turned the world, as we had known it since the day we were born, topsy-turvy. Rules, written and unwritten made way to strange ones.
Covid had us hesitant to sneeze. To cough. Even to talk and sing out loud. Masks make familiar faces look strange. Covid bolted places of worship, something beyond imagination of the human race which races to God to get things done, and of late, more often than naught, sets man against man in His name.
Covid shuttered cinema halls, modern-day malls and multiplexes- ‘Meccas’ of the so-called new-gen. Covid clamped brakes on celebrations, on festivals, on extravagance at weddings, baptisms and birthday parties. Those paled in the sheer terror the unbridled virus let lose in terms of death and infection-mortality and morbidity as men and women in white coats refer to.
Just as I am writing this, the world has lost 524,751 from among the 11,017,084 infected. India lost 18,213 from 626000 infected, while Kerala lost 25 from the 4,753 infected. More than ‘Covid’ being heard all-around like thunder peals during summer rain, what’s unnerving is the magnitude of the trail of death and disease it continues to leave behind its disastrous trail.
Healthcare providers have been buried under the avalanche of statistics that appear demoniac. Worse, they have drowned in unsubstantiated jargon. Claims of having developed a vaccine, and effective drugs spewed from social media and medical journals, the wheels of which have been turning overtime since late December of 2019, when the virus first debuted in China’s Wuhan.
Many drugs have participated in the catwalk; Hydroxychloroquine, vitamins C, D, Zinc, Aspirin, Heparin, Clopidrogel, Dexamethasone, Favipiravir, Remdesivir, early oxygen therapy, Convalescent Plasma Therapy, prone ventilation, and ECMO. In India, cow dung, cow urine, and even Patanjali’s ‘Coronil’ too have joined the queue, but none has been crowned clear winner.
None has secured the crown. A distinct game changer is missing in the crowd. More sordid is reluctance of an effective vaccine to emerge. Right now, nations are inching forward to touch the ribbon in the race to develop a vaccine. Will there be a clear winner? Or will it be a photo-finish? Even if there’s a winner, will it prove its efficacy against a virus known for its propensity to mutate? Will we have credible answers to these questions that seem difficult?
Until then, as shouts of ‘Covid’, ‘Covid’, ‘Covid’, echo about us, it is likes of the patient I had mentioned who will repose semblance of sanity in me, as a healthcare provider, which I doubt his family will feel the same about.