Dr. Donnah de Leon likes to assume that for new coronavirus disease (COVID-19) patients who had been on a respirator for some time, dying would be painless and uneventful.

“Patients are in a deep sleep, which is part of management for them. They are sedated to the point that they are not easily roused. So, we might assume that they die peacefully in their sleep,” she said.

“But knowing the physiology of the human body, the patient could have been struggling, based on the laboratory parameters. It is something that we, as doctors, are thankful for—that we don’t see our patients dying and struggling for their lives.”

De Leon said a typical 12-hour shift feels like a 48-hour duty. She is an internist-nephrologist, head of the peritoneal dialysis unit at the National Kidney and Transplant Institute. She is also affiliated with the Pasig City General Hospital and Manila Doctors Hospital. Her workdays are so full they “can sometimes be a riot.”

Basic instinct

When news of the pandemic broke, De Leon did not think twice about volunteering.

“I think it is the ‘basic instinct’ of being a doctor—ready to help, to cure, and if everything else fails, even just to alleviate and give comfort to the sick. It’s an instinct inculcated through years of training and sleepless nights. We are the guardians of the night at all times,” she said.

She remembers how doctors had to reorient themselves with personal protective equipment (PPE) during the early stage of the pandemic.

“This seems easy, but relearning how to put on our PPE, doff and remove our PPE, feels like you’re going back to Grade 1, when you were learning how to write. You have to follow every stroke and every move as they are being taught,” she said.

She remembers the fear among her colleagues when they first entered the COVID-19 floor of Manila Doctors.

“This is such unknown terrain, and we were entering a very, very dangerous and potentially deadly environment,” De Leon said. “It is depressing, especially when you know you have colleagues confined in there.

“This is not the usual painful disease, but the symptoms come like a thief in the night. In the morning, you see them up and about, but by nighttime, they can be gasping for air, and sometimes at that very moment they succumb to the disease,” she said.

The sad truth is, she said, no matter how well doctors think they know medicine, they still end up with a patient progressively deteriorating.

Pray

“No amount of knowledge at present can help treat a patient once they come to a point where their lungs fail. The only thing you can do is to pray for the patient, that he or she might still have a peaceful exit,” De Leon said.

But it’s precisely the roller-coaster of emotions she experiences on the COVID-19 floor that makes her go back the next day, more determined to comfort the sick. “If someone asked me if I would go on duty again, the answer would be yes.”

De Leon recalls a time when two colleagues, a couple, came down with the disease. The wife was worse off, so the husband took care of her himself, including doing duties usually relegated to nurses. He was no longer eating and sleeping, monitoring his wife’s condition from morning to dawn.

“We repeatedly warned him that his constant exposure to the disease could only worsen his condition. But he didn’t listen: ‘Kaya ko ito,’” De Leon said. “I understood what true love and dedication is all about. And you will be amazed how God works. His condition did not deteriorate despite the constant exposure to the virus.” (His wife, unfortunately, did not make it.)

“It is a focused goal to try and save lives every day. You can’t win a battle that you don’t believe you can win. So, like a soldier in the battlefield, your aim is focused on the invisible enemy. And the only way to win this is to remain focused and trust in your ally—the One up there who will guide you and direct you,” De Leon said.

“Among all armamentarium, prayer is a very powerful source of security, serenity and peace. We all have to step back and lift it all to Him, for tomorrow will be another day,” she said. “At the end of your shift, there is still work. You read, you contemplate, you revise strategies for management.”