COVID Warrior: A Doctor In Emergency Department Of A Mumbai Hospital Explains How Fighting COVID-19 Is Mentally And Physically Draining

New Delhi: Nearing almost a year of the COVID-19 pandemic outbreak in China of December 31, 2019, cases in India are seeing a slight dip in for the first time since April. However, the unground reality for the healthcare workers in India more or less remains the same. Long working hours, disconnected with their friends and family, and a job that puts them at risk of both physical and mental health issues. Dr Shweta Tyagi, Consultant at Mumbai’s Sir HN Reliance Foundation Hospital’s Emergency Department has been practising for over a decade and has been fighting the pandemic on the frontline since it began.

Dr Tyagi usually has an 8-10 hours duty, but she and her team end up spending extended hours at the hospital. Moreover, she says that the ER department is on call 24/7, where they keep getting calls, even during their off shift, for medical advice.

Being in the emergency department, Dr Tyagi often meets suspected patients and even such patients who show no COVID-19 symptoms but later turn out positive. Sharing her experience in the ER amid a pandemic, she said,

Whenever patients and relatives visit ER, they are already highly anxious because of this visit is never a planned visit. There was obviously some emergency situation because of which they rushed to the ER. Even before COVID-19, their visits would be associated with anxiety and fear as they would visit for reasons like accidents, heart attacks, strokes or even abdominal and kidney issues. The pandemic has, however, increased the anxiety by many-many folds. We the doctors, in the emergency department, are expected to be prepared for anything and everything that comes through the ER door. Read and understand the situation accurately and fast, so that we can come up with the correct diagnosis and hence provide the appropriate treatment for the patient.

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It is a huge responsibility that ER has as it is of extreme importance to diagnose appropriately; any misdiagnosis can lead to a lot of issues for the patient, she said.

ER is the face of any healthcare crisis and with the ongoing pandemic, it has become even more relevant, Dr Tyagi explained.

The pandemic has also raised certain communication challenges caused by the safety measures, like the mask, PPE kits, the doctors have to wear at all times. Dr Tyagi explains that these hinder the interpersonal communication between the doctors, patients, medical staff as well as the relatives.

Because of COVID, the relatives have been restricted, they are not allowed in the hospital and without their presence, it gets difficult to communicate with the patient, and comforting the patient. On the other hand, we communicate with the relatives over the phone and update them on regular intervals, but there are certain communication gaps on the phone and the personal touch of doctors is not present to comfort them either. Most of all, we have to manage both the sides, because the worry is on both sides. This is just an extra burden on us.

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Furthermore, Dr Tyagi says that working in the ER wing of a non-COVID hospital means you have to be extra alert for other patients’ safety. Also, patients are scared to visit hospitals too, as they perceive it as a threat where they may contract the infection, which is why following every precaution and safety protocol is of the topmost priority. She says that they try their best to ease the fear of the patients who are visiting the hospital for other important and critical medical conditions like cancer, kidney dialysis, and even other comorbid patients.

We are in out full PPE gear at all times at the hospital, even though we are a non-COVID wing, because some patients who show up at the ER may later test positive. Safety protocol mandated the Emergency department in the PPE kit 24/7. Now, its not that just the patients who have respiratory symptoms are testing positive. Over the last 5-6 months, we have seen so many cases that have come to the ER with acute stroke, heart attack, abdominal symptoms like pain or vomiting. We thought these to be gastritis or pancreatic issue, but it eventually turned out to be COVID-19, says Dr Tyagi.

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Dr Tyagi says that even breaking this news to the patients and their relatives is a huge challenge as they are in the state of denial. They are aware of certain symptoms which are not the same in their case.

That’s when extensive counselling from our end is needed along with following safety protocols and shifting them to the COVID wing for isolation. Even telling them that their relative is being shifted to the COVID wing and they will not be allowed, is just a very difficult situation which can take a toll on mental health for not just the patient and relatives but the doctors as well, she said.

At home, Dr Tyagi isolates herself from her elderly parents who have comorbidities and 9-year-old daughter.

Going back home after work is a scary situation as well. I have elderly parents at home, who are vulnerable to COVID-19. So knowing that there’s a risk associated with my parents because of me, is not easy. My parents have comorbidities, so I have been isolating myself from them in the same house. My husband is a Pulmonologist, so he’s also doing COVID work. We have a 9-year-old daughter who is being taken care of by my parents and I have no contact with her as well. We as doctors still understand the risks invited but making the family members understand, it is a little difficult.

Dr Tyagi says that the mother-daughter bonding is one of the most important things that she’s missing out on due to the restrictions of COVID-19. But the duo has figured out a way to spend time with each other and bond, with social distance in place. She explains,

We can’t cuddle or hug, so we have started watching a web series together, The Gilmore Girls, which is also based on a mother-daughter relationship. So, my daughter looks forward to the time we spend watching Gilmore Girls from a distance. To bind with the rest of my extended family, we also host frequent group video calls with in-laws, every alternate day. My daughter has bonded a lot with her grandparents as they are parenting her full-time. Right now, they have their own life while me and my husband are like guests, who come and eat food and leave for long hours at a stretch.

While the situation is difficult, with no end on sight, Dr Tyagi says that it is her team at the hospital that motivates her and keeps her going through this.

My team in the emergency department has been really supportive and my brilliant colleagues and coworkers who have made us proud through their relentless 24/7 work for almost seven months now. None of us has got leaves, or off days in the last few months. We have been continuously on the frontline and to keep the team motivated is a huge task. They are anxious about contracting the infection as well. Anyone who develops symptoms needs counselling, it is not easy to counsel my own team, my nurses, my staff. But they have done a really good job and made us proud. My team works 24/7 without breaks, is a driving force that motivates me. We try to become an example for each other, looking up to each other. This gives us a push that we require to keep going, Dr Tyagi signed out.

My team works 24/7 without breaks, is a driving force that motivates me: Dr Shweta Tyagi

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.