Back in January, I was doing the rounds at the ICU with an extraordinary patient, a doctor herself, a grand dame of Philippine pulmonary medicine. It was more of her being the preceptor and me being the student once again. We were learning a lot from each other—me from her experiences, she from my updates.
One day, she was watching CNN, which was reporting on a new viral infection spreading in China. She told me, “The mortality rate is higher than influenza, mag-ingat kayo diyan. Aralin mo yan.”
Right in front of her I whipped out my phone, and we read UpToDate (a medical resource app) articles on this new viral pneumonia spreading in China. Doctora has long since been discharged, and is now resting at home.
Ever since the threat of COVID-19 arrived on our shores, I’ve been trying to keep myself informed and updated. My boss, the one with the double specialty in pulmonary medicine and infectious diseases, made sure everyone in her team got the necessary new information. As early as January, we were preparing for the admission of persons under investigation (PUIs) at the Isolation Unit of our hospital. We were having demos on donning and doffing personal protective equipment (PPE), conducted by our boss herself. It’s like she made it her personal crusade to lead us through this battle.
In the last week of January, I had my first encounter with a PUI from China. She had the symptoms, she did not have co-morbidities and she was relatively young. Thankfully, her swab was negative.
COVID-19 has imposed a necessary detachment between us that makes me sad. I haven’t been able to sit closely with friends, or talk at normal distance with colleagues. I haven’t gone home to see my parents for fear of bringing the infection to them, especially my dad (a hypertensive), and I postponed a planned vacation with my 85-year-old lola. The kisses and the hugs will definitely have to wait.
Communicating with patients and their relatives has become less personal. The necessary layers of PPE make it impossible for patients to see my reactions, the N95 requires me to speak with louder voice, and the suit looks menacing. There are times in the ER tent when patients have to stop themselves from squeezing my arm, as if to tell me they are anxious and they want a reassurance that everything will be all right. I, too, have stopped myself from putting my hand on the shoulders of daughters and sons, husbands and wives, not to promise them anything, but to let them know our team will exhaust all possible means known to science to nurse their loved one back to health.
Pulmonary medicine is critical at this time because the manifestations and complications of COVID-19 are severe pneumonia, acute respiratory failure, acute respiratory distress syndrome—and then the other organ systems start to shut down. Being a COVID Referral Center, our hospital accepts both PUIs and confirmed cases with moderate to severe illness, especially the severe. As much as we want to accept everyone who comes to us, every day we are overwhelmed; we are simply limited by bed capacity, personnel and supplies. Sure, we can add tents in the parking lot, but that simply won’t work if we have only two nurses carrying out all of the tasks to the point of exhaustion and breakdown.
Selfless and steadfast
The nurses and the nurse aides—God bless them! I simply would not have been able to do what I had to do had they not been selfless and steadfast. These nurses are used to patients in respiratory distress or multi-drug-resistant TB, yet nothing prepared us for this. We have heard of doctors and healthcare workers developing severe illness, some of whom have died after intubation. This is a nightmare.
I am sorry that the situation I am in adds to the fear and anxiety of those who care for me. I am very conscious about PPE use and infection prevention. I am worried that a member of the healthcare team will be infected in the line of duty. It has become a conscious effort for me to give each member of the team a PPE head-to-toe assessment, and I ask them to do the same for me before I head out. It saddens me that the necessary PPE takes away a layer of humanity and empathy toward our patients and their relatives. I am sorry that when COVID patients die, they are robbed of dignity, without regard for the love they once enjoyed, the colorful lives they once lived, the many people they touched and inspired, how they imagined their funerals would have been like—only to be put in a bag with the clothes on their backs, into the crematorium fire.
At the “command center” for front-liners, we have a database of all the patients we have encountered. This is where we plan how to manage our patients, where we mourn the fallen and rejoice for those who have recovered. These past three weeks have taught us to give our best, to work as a team, to synchronize our movements, to paddle like dragon boaters to the beat of safety and efficiency for the success of our patients’ treatments.
It’s probably not surprising that most of my waking moments are spent thinking of COVID-19. I used to laugh at my boss and how she lives and breathes COVID; I never thought it would happen to me, too. I try to watch something on Netflix, then a notification comes up about new articles on COVID, and I end up reading those instead. If I’m not doing COVID stuff, I’m meeting donors and receiving their gifts at the hospital lobby, taking a picture, and sharing our immense gratitude for remembering us during these trying times.
I am grateful to the people who continue to remember us despite being fearful themselves. I have lost count of the numerous messages of comfort, prayers and encouragement that keep me going. I am thankful to those who connected with me through social media: relatives, friends, friends of friends, complete strangers who have sent us all sorts of food, rubbing alcohol, face masks, hygiene products, surgical gowns, coveralls, raincoats, garbage bags, rolls of toilet paper, face shields, bouffant caps, gloves, booties, Safeguard soap. We are so overwhelmed with the love and concern; you all inspire us to keep going, and you give us hope that we can win.
I pray that no more healthcare workers will die of this disease. I look forward to the day when the cases decline and we send the last fully recovered patient home to his or her family. I want us to live normally again—to be able to hug our parents, to watch a movie, to go to school and play with friends, to attend meetings and give firm handshakes, to ride a jeep and magpasa ng bayad sa driver. I pray COVID ends soon.
I thank other healthcare workers sharing the burden in this ordeal. I pray for your safety always. I thank people staying at home and maintaining social distancing, doing hand hygiene, covering their coughs and sneezes, and cleaning surfaces. Through this, you can stop the spread of the virus.
Lastly, I am thankful to our generous donors, corporate and individual, for sharing. I hope all the supplies reach their intended recipients.
Dr. Anna Regina “Reggie” C. Feraren is medical officer and pulmonary fellow at the Pulmonary Medicine, Critical Care and Sleep Medicine Department of the Lung Center of the Philippines.