A Pickle Jar Ritual
By: Dr. Shalini Miriam Ipe
Tags: Covid 19, Hospital, Doctors, India, Covid 19 Crisis

It’s ofcourse odd to start your day by smelling a pickle jar. Crazy as it may seem, that’s how my day begins. I am a doctor, an anesthesiologist, in simpler terms… I am the “sleep lady”. For the past one year or so we have all been baptized into a new cult — the “Covid Warriors”.

Having woken up with chronic headache for a good part of the year, I wake up and walk straight to the pickle jar and smell it. If I can smell it, I will go to work and if I can’t, well then I would need an RTPCR. So I pop another pain killer, hands on my temples, sit down with my tea and flip through the newspaper. I see lots of numbers, but I don’t see any mentioning the local shortage of oxygen, ventilators, medicines or the facility to fight Covid. Hmmm, I can’t dwell on it, “the pain killers have burnt a hole in my stomach” I tell myself. I have eaten enough to cremate my own liver and kidney.

The day starts with me waking up my cranky lil kids, with the usual bunch of instructions to them about being responsible, knowing very well that they have nothing to do and no where to go ,thanks to both their parents and their grandparents being ‘Covid Warriors’ as well.

As it’s time to go, weary aching legs carry me to work with a lack of oxygen, the familiar shortness of breath and my pounding heart under the N95 mask. I make plans for later, in my tired head, to cook something special for my kids, or to play with them, knowing well that this day will end with me crawling into bed after work.

Walking into the hospital I see people worse off. We all look haggard, in different uniforms that designate our roles. All of us super heroes donning masks, shields and body suits. Few of those blood shot eyes, smile . For me its my own reflection. Permanent marks and bruises from masks and head gear, ungloved hands like skinned salmon, raw from all the glove powder and sanitizers. We exchange the numbers of new cases, the ever mounting complications and the ones who we couldn’t save, mixed with worry about our own.

Once inside the operating room, we change into battle gear, putting on uncomfortable layers, till we feel the ‘normal’ amount of suffocation. We put layers of plastic and gloves and masks and our PPE buddies stick plaster on to our skin to seal us in tight(much like a pickle jar).Having taken a few breaths, I am blind from the fogging on my head gear and deaf because of all the layers. Everyone does everyone’s job now. While in the past we spent time allaying our patient’s fears and talking to them till they welcomed unconsciousness, now we stay away from all those aerosols that could spell our doom.

When a Covid patient comes in for surgery, it requires a lot of coordination. Information is relayed to the public relations officer who coordinates clearing off the area, while personnel clad in PPE transport the patient to the designated spot, all the while spraying sanitizer. In the OR we often do not turn on the air-conditioner, fearing aerosols(even with negative pressure systems).

Many of my colleagues have collapsed working in PPE, if the reader is curious, I urge you to cover yourself in plastic sacks and put another over your head and seal it shut and just for kicks stand out in the sun and walk around!!

As the number of cases rise and the task at hand seems unsurmountable, we sit in this bag(PPE) ,smoldering and evaporating…..the lack of oxygen and the abundance of carbon dioxide, put us in a trance. I think to myself maybe I can nap in this thing, it feels as heavy as a mattress anyways. Vision clouds and the funny thought of how “all of us look like Easter bunnies” pass through my mind.

Thankfully the PPE is forgiving to all except extraordinarily large folks. A colleague of mine couldn’t stop laughing as she talked about the time she heard something rip while tubing a patient in Covid ICU. Every thing we try to do takes a long time. Our senses are dulled ,our limbs betray us. Procedures are difficult because of lack of proprioception and vision. Shifting a patient to ward or ICU take an impossible amount of time due to the safety precautions. With the ordeal finally over, it’s time to de- robe. We spray dilute solutions of floor cleaners before we doff(slang for de-robbing the protection kit). We remove it in an orderly manner(when we aren’t too out of it),off comes the shield and the layers of masks and gloves and I wish if only I could get my slipper from the foot cover without fishing for it. I am soaked to my skin, hair slick with sweat and gallons of water lost from within. I need to bathe before I can think of a sip of water. So I am off to bathe in antiseptic and scalding hot water .We are bathing so often we are tones lighter and one can appreciate the loss of skin and hair and reddish purple marks from where the plaster kissed away some skin. And before you think that’s it for the day, let me just pitch in that this was just one of my first procedures for the day.

On duty days calls from intensive care units and wards average 3 or more a day. Panting and puffing having climbed more steps than I want to count, I reach to see a 30 something year old patient who is in need of me. As my vision clears and my thumping heart slows, I can see the dread in his wide open eyes. He is sweating and breathing as if he is drowning. Sitting up with high flows of oxygen, amidst complicated monitors and equipment blaring alarms, is the man I have to tube today. The tired haggard nurses brief me, while arranging for intubation. I dread talking to the patient, because they often have two questions for me — it’s either “Doctor could I have some water?” or “Doctor will I die?”. I cant meet his eye and am thankful I can hide in my white tent for once. I tell him these medicines will ease his discomfort, that he will be alright and that there’s nothing to worry. Trusting me, he goes off to sleep, having seen a stranger with no face and a muffled voice in a white suit before rejoining his maker.

I can see you knitting your brows when you read this. It’s all part of the job you say? Amidst all the glorification on social media and medals promised, you fail to see the human in the suit. You fail to see the helpless and disheartened individual who leaves work carrying the weight of his patient’s loss on his soul. We keep asking ourselves if there was anything more we could do. I would have called it PTSD if this was behind us. But the story I am telling you of every doctor and nurse and personnel associated with a hospital during this pandemic, is not over yet.

When the first wave of the unknown hit us, we all flocked to the television listening to our Honourable Chief Minister talk about Covid. Even double digits struck terror in our heats back then. Now we have added many zeros to that. The TPR is around 30%, Oxygen is in short supply, we are running out of ventilators and beds. In households were there are Covid positive patients, the rest of the members are being directed not to test even when they have symptoms.

You do the math… considering an average of 3 in a house in Kerala, the actual numbers are significantly higher. Test positive rates in other states are 50–60 %. Doctors all over are reviewing articles, information, vaccines, treatment and ventilation strategies through scientific review. What does all this mean? Almost one out of 3 people in our state maybe Covid positive. The new wave has even healthy 30 to 40 year olds fighting and often losing their battle to this dreaded disease.

The sad truth is that our health system is overwhelmed. When you venture out putting your life at risk, we are unable to help you ,even when we want to. Yes, it’s unfair but every time you are forced to stay home, giving up your freedom of movement, I plead you to spare us a thought. As doctors, we cannot choose to stay home, to safeguard our loved ones or ourselves. Stay home for those of us who pick up our children with fear in our hearts, consciously staying away from all those we love. As we are called upon to do our duty and our oath to the service of mankind, we the medical fraternity have a little prayer to our fellow citizens, “live with the knowledge that our lives are as much in your hands as yours are in ours!”

— Dr. Shalini Miriam Ipe, MD