Doctors fight war on the COVID frontier

NICOLA MILTZ

It was there 20 years ago that the couple first met, having no idea that they would be doing night shifts together years later and seeing dozens of patients stricken with a disease named only seven months ago.

“I never thought at this stage of my career I’d be back in casualty,” said Dave, 53, an endocrinologist. He was part of a team of eight specialists who set up the COVID-19 service at Groote Schuur Hospital. They have been at the coalface of the surge in cases in the province during the raging pandemic which is now in full swing in Gauteng.

The SA Jewish Report spoke to doctors in the community, all of whom are making extraordinary sacrifices to save lives.

“Your emotions are up and down depending on what you are able to do for the patient. High flow nasal oxygen is saving patients’ lives, and this is incredibly rewarding. There are horror stories, but many lives are being saved,” said Dave.

Doctors are witnessing patients perilously ill, gasping for air in spite of the highest amount of oxygen flowing into them. In some hospitals, they barely have time to search patient records to catch a glimpse of who the patient was before coronavirus engulfed them. Exhausted and shell-shocked, they try to keep their composure, maintaining a sense of purpose to get them through the day.

As the wards of both private and state hospitals fill up, doctors are being redeployed into COVID-19 wards where the daily drama of the pandemic unfolds before their visor-blurred eyes.

Wearing full, constrictive personal protective equipment (PPE), doctors’ voices are muffled and their facial expressions obscured. Behind their masks, they strain to hear each other speak. “This gives new meaning to the healing presence of the bedside physician,” said Dr Carron Zinman, specialist physician pulmonologist at Netcare Linksfield Hospital.

Doctors speak the language of war. It’s a bizarre time, when even breathing the same air as your patient is risky.

“Patients have a look of fear, worried that they might become another statistic in tomorrow’s death toll,” she said. “Normal life is on hold. Indefinitely. I feel like I’ve stepped into a surreal, completely different world where everything is the same but totally different.”

“Last year I had two cases which caused me untold stress. Now I’m having 20 to 30 cases a day,” she said.

Last weekend, she and her partner saw 90 patients a day, with 41 admissions. They have signed multiple death certificates. “It’s distressing not being able to contact the relatives of each patient regularly who you know are worried sick. There’s simply not enough time,” she said.

Hospitals have transformed into pandemic-focused mini-cities in a bid to deliver the best quality medicine with healthcare teams working fearlessly together.

“My examination room is now a dressing room, re-usable masks are labelled with our names and placed on the windowsill to catch the sun. There is a washing machine to clean scrubs,” said Zinman.

There is a mindboggling ritual of doffing and donning PPE followed by meticulous hand washing and showering as doctors, nurses, and all hospital staff move between the COVID-19 ward and the Patients Under Investigation (PUI) ward reserved for patients displaying symptoms of the virus and awaiting test results.

Public health surgeon, Dr Eloise Miller, 38, of Charlotte Maxeke Johannesburg Academic Hospital switched to the intensive-care unit when she saw the need arise.

“Right now, it’s work, home, work, home. This isn’t a happy story. It’s like a war zone. I’m used to working with critical patients and unfortunately losing patients, but this is on another level. We are staring death in the face every day. It’s so sad.”

“The skills of our doctors and standard of care in ICU is similar to any private hospital. The problem is that by the time our patients come in, it’s often too late. Their lungs are completely infiltrated. Patients are profoundly hypoxic, and you watch them deteriorate before your eyes.”

She said that the majority of patients infected will survive, but once they are in hospital and are much sicker, the survival rate isn’t good. “This isn’t an ordinary flu, it’s a new frontier. We won’t all get to the other side. No one can understand the complete hopelessness and senseless loss of life, and it’s going to get a lot worse.”

Dr Gordon Kretzmer, 55, an intensive-care physician at Netcare Sunninghill Hospital, is recovering at home after contracting the virus. “I knew I had it. I had seen so many patients, it was obvious,” he said.

Fortunately, he had it relatively mildly, and is now preparing to go back to work.

“It’s a stressful time dealing with a very unpredictable disease. We have done everything to prepare ourselves. We’ve read every single article and yet everything is experimental, nothing is proven. People can deteriorate very rapidly after presenting mildly.”

Father of two, Dr Lior Chernick, 33, is a medical registrar at Chris Hani Baragwanath Academic Hospital. “Working in state health, you function on the edge at the best of times. Now we are pushing things over the edge. People are stepping up, they are committed, but sadly there is no shortage of colleagues who have fallen ill with it,” adding to the burden of all-round staff shortages.

The very nature of this novel virus “makes you engage with your own mortality”, he said.

“While the majority of patients are discharged, many experience fear and anxiety which is amplified when they see patients around them dying,” said Chernick.

Dr Barri Strimling, 33, a registrar in radiology at Charlotte Maxeke, moved out of home when he was redeployed to the COVID-19 wards last month to avoid potentially infecting his young family. He waved goodbye to his three-year-old twin toddlers, Kira and Jacob, who he said pray every night for “daddy to save the sick people”.

Strimling said he had been hugely supported by the community. “My wife, Romy, posted a request on Joburg Jewish Mommies for accommodation, and we were blown away by offers,” he said.

He is currently staying at a bed and breakfast courtesy of Ubuntu Beds, an initiative that aims to unite empty hotels with healthcare workers on the frontline.

“It’s all hands on deck. Doctors have gone back to their roots to help each other. It’s not doctors versus COVID-19, it’s humanity versus COVID-19. There’s a complete ecosystem at play. We are all in this together. We become the patient’s family.”

Rabbi and Dr Shauli Minkowitz said as a training urologist at Baragwanath, it was difficult to offer the same level of care and compassion as before. “We are limiting face-to-face consultations to reduce patient risk, and are forced to delay many procedures that are deemed non-essential in order to keep people out of hospital and free up beds for COVID-19 patients,” he said.

“It’s a trying time with our hands [scalpels] tied behind our back, but now more than ever, it’s incumbent upon us to be more empathetic and sensitive to the physical and spiritual needs of those who seek our help. If we as doctors find it hard, imagine how our patients feel!”