Death, desperation, and making a difference every day

The sheer number of new cases announced every night speak for themselves. For us, it translates into upwards of 20 admissions per day. There are times when every bed and chair is occupied in emergency, and ambulances are lined up outside with patients on oxygen or even CPAP (continuous positive airway pressure) in extreme cases. We work as a unit clerking as many new patients as efficiently as we can so that we can get them into a hospital bed.

Our hospital made the decision to accommodate as many patients with COVID-19 as possible, and it has been a moving paradigm, with more and more wards converted into “red” units. COVID-19 now occupies six general wards and two intensive-care units (ICUs), allowing for upwards of 170 patients with 40 in ICU. The ICU patients are very ill, with 80% of them on ventilators. They are a younger cohort – 97% younger than 70, with the average age younger than 55. The same comorbidities are at play, but there are more people who have no comorbidities at all.

Every morning, we walk down to the donning area, where we are wrapped in multiple layers of fabric and plastic until only the area around our eyes is showing. Dressed for battle, we walk through the doors into an ICU that still looks surreal. Every single patient has a mask strapped to their face or an endotracheal tube down their throat. Calm and control no longer exist, and there is often a frantic physician running to a resuscitation or trying to find a bed, a ventilator, or both. COVID-19 remains unpredictable, and the rapidity with which a patient’s condition changes still takes us by surprise. Resuscitations are far more common this time around, and more often than not, the patients are younger than we are. Ventilators and ICU beds are at a premium, and whoever sees an empty bed first calls dibs so that they can move one of their patients up from a ward. We haven’t as yet had to make the decision to take a patient off a ventilator, but there are clear criteria for this eventuality, and there are hospitals which have had to do this.

Patients with COVID-19 need far more oxygen than non-COVID-19 patients do, and when the demand on our oxygen supply soared, pushing us to the limit, the hospital invested in concentrators to serve patients on nasal canullae.

Bed three is occupied by a young woman who has an underlying autoimmune condition. She has been mechanically ventilated for some time now, and is stable. Her mom has contracted COVID-19, and cannot visit her. She has made us promise that if things go wrong, we won’t allow her daughter to die alone.

We move onto a woman who has every comorbidity in the book. She was on NIV (noninvasive ventilation) and refused mechanical ventilation. She worked very hard to keep breathing through the COVID-19 pneumonia, and survived. She endeared herself to all of us with her gentle nature, her gratitude, and quirky sense of humour – she offered to lend her NIV to our medical officer who was exhausted after a really rough night.

In contrast is the person who chose not to be ventilated, and didn’t survive. Her entire family had COVID-19, and couldn’t visit her. The nursing staff facilitated video calls on a daily basis so that her husband and children could maintain contact with her. The family even went so far as to request that the video remain on while she passed away so that they could be with her.

There are far more patients this time round who fail NIV and require mechanical ventilation. Once again, we are privy to the final phone calls that they make to their wives to express their love and say goodbye. They are justifiably anxious, and we hold their hands as their eyes drift closed trying to imbue a sense of calm. Ventilating COVID-19 patients is challenging, and we use less usual modes of ventilation and often prone them.

A thought-provoking encounter was with a young pastor who had been very ill in the COVID-19 ICU. I wondered what his take on this pandemic was, and he replied that G-d has nothing to do with illness but will always be with you when you are ill or dying. He said his faith in G-d had been affirmed by profound spiritual experiences in ICU.

We witnessed a disquieting conversation between a patient and Martins funeral parlour. He was making arrangements for his own funeral in anticipation of his demise to save his family the bother.

A bizarre experience was when a man whose wife had died the day he was admitted to hospital was found eating breakfast while watching her funeral on Zoom. This wave has been a family affair, and there are often several members of a family admitted to the same or different hospitals. It’s not unusual to see a patient in pyjamas and mask being wheeled to visit a spouse or someone in another ward.

It’s difficult to explain the desperation we feel when we admit a pregnant or post-partum woman, and when one such patient dies unexpectedly after being with us for a few weeks. I bore witness to the tears on every battle-hardened nurse and doctor’s face. It was the last straw.

The consequence of the number of admissions we’ve had is the high number of deaths that we’ve had to contend with. Many will haunt us forever, and we drift off to sleep seeing their faces and replaying conversations with their families in our minds.

We feel as if we are treading water and barely keeping afloat. We are exhausted and overwrought. We have been battered by this experience, but know that we just have to keep going. And we reassure ourselves, and each other, that we do make a difference, and that the majority of our patients do go home. We celebrate each survivor who leaves a COVID-19 ward.

• Dr Carron Zinman is a pulmonologist at Netcare Linksfield Hospital.