By B.C. Thimmaiah and M.T. Yogesh Kumar
It is on the shoulders of these frontline workers — or call them saviours — that the bulk of the burden of fighting this pandemic falls. Doctors put themselves in harm’s way to help their patients and in this trying times public confidence on doctors has increased manifold. The sacrifice that they are making for the safety and welfare of humanity is priceless and deserves lifelong gratitude. In this special article, Star of Mysore chronicles the services of Post-Graduate students of Mysore Medical College and Research Institute (MMC&RI) in Mysuru’s hour of need and also features a student-doctor from abroad who is serving her hometown in the midst of contagion.— Ed
Wearing PPE kit is like being inside a hot sweat chamber
‘We too suffer like patients who are having breathing problems’
For doctors and frontline workers, Personal Protective Equipment (PPE) is the first and most crucial line of defence against COVID-19. PPEs are vital to prevent transmission as they create an uncontaminated interior considerably limiting the risk of infection but protection comes at a cost.
“Long hours in PPE suits give rashes and makes breathing difficult. Eating, drinking or even going to the loo is out of the question during duty hours that can last from 6 to 8 hours and may even stretch upto 12 hours in the night,” says Dr. S.S. Abhishek, who is pursuing his third year PG in General Surgery at MMC&RI.
“PPEs make us feel very hot and because of the heat, sweat keeps dripping down the face, which you can’t wipe away. Since the first wave, we have been going through terrible physical and mental stress and we too feel like patients who are suffering from breathlessness,” he explains.
It takes around 10-15 minutes to don the PPE and 15-30 minutes to take it off while observing all infection-control practices. Communication is difficult as other people cannot even see your lip movement and the doctors have to speak loud. Also, the vision through the face shield is less than perfect.
Doctors’ shortage in red zone
Hailing from Sagar in Shivamogga, Dr. Abhishek works in an orange zone (mild to moderate serious patients) at K.R. Hospital. “Last year, the lockdown was strict and the decision was taken early. But this year, the restrictions were announced late and people had let down their guard. In the first wave, we were asked to work on one day and take off the next day. But this year, we are working continuously with one day off a week. We put in 6 to 8 hours during day time and 12 hours in night shift,” he says.
The Government healthcare sector in Mysuru faces severe shortage of doctors, especially in the ICU (red zone). To fill the shortage, almost all the 110 to 120 PG students have been deputed to various healthcare facilities like the K.R. Hospital, Jayadeva Block, Stone Building, Trauma Care Centre, PKTB and District Hospital.
“As per the Government’s own rules, it should be 10 days of work (8 hour shift) and quarantine for five days. But due to shortage of doctors, we are asked to do continuous work, increasing our exposure manifold. Even I had tested positive but after recovering, I reported back to work. We have no choice. Almost all the Post-Graduates at MMC&RI are doing this work since the first wave,” he narrates.
Not allowed to write exams
“The worst that could happen to the Senior Resident doctors is that due to shortage of doctors, they are not allowed to write their exams and pursue their higher studies or practice. It is a huge loss for them as their academic year is extended by at least 7 months. The Government should conduct examinations and consider this extra period of service in the bond for the mandatory Government service,” he asserts.
On the pandemic per se, Dr. Abhishek feels that people are afraid to get tested. Also, the Government has slashed testing numbers in order to show less Total Positivity Rate (TPR). “The first five days of the infection is critical. It is either people go for self-medication or they approach quacks. This is how asymptomatic patients become complicated cases resulting in deaths. Ideally there must be quick tests and quick results,” he says. Personally, Dr. Abhishek has seen many worsening cases. “Negligence is killing people,” he says with a sigh.
‘Our careers at stake due to certain illogical decisions’
Students are paying fees without any learning; they are just doing COVID duty
We are happy to serve COVID patients and fill in for the shortage of doctors. But the Government too must consider our plight and save our careers. We are only doing COVID duty now and certain illogical decisions of the Government are affecting our careers and lives,” said Dr. Ronak, who is pursuing his Senior Resident in General Surgery.
Medical graduates and residents are facing confusion, uncertainty and frustration about their training pathways in the wake of the pandemic. “We are put on COVID outbreak duty during a transitional phase of our medical curriculum. It’s a time of year when Senior Residents gear up for their final assessments and MBBS graduates who have passed the National Eligibility-cum-Entrance Test for Post-Graduate (NEET-PG) courses begin to explore their Residency choices. This pandemic has confused us as to how to progress in our careers,” he says.
Hailing from Nilambur in Kerala, Ronak says that Resident Doctors have been obliged to work relentlessly in isolation wards and ICUs. “The Government has extended our tenures due to the shortage of doctors. But this will affect our careers and it is not the right thing to do. We have junior doctors who are studying since more than a year for NEET. Now they are doing COVID duty and there is no time to study for one of the toughest exams,” he explains.
“On the one hand, the Government says that it cannot expose doctors to COVID by conducting NEET and on the other hand, the same Government puts us on COVID duty where lives are at risk. Isn’t this double standards? The pandemic is not new. We are ready to work but the Government too must assure us that the bond is waived off. We must get financial stability and also allowed to make career plans as we would wish to. Even we have dreams of settling down and taking care of our families,” Ronak adds.
After April 30, Ronak has to become Senior Resident but the Government has not considered this. “The Government must not extend our bond beyond one year. If the bond is extended, it will be difficult for us to go to the next step or the super-speciality level. What we are undergoing now is an additional mental stress apart from the stress and risk to life in COVID wards. We don’t have the guarantee when the exams will be conducted by RGUHS. Many States are conducting exams but Karnataka is not thinking in that direction,” he regrets.
Loss of knowledge, loss of skill
Even PG students are not studying. They are just doing COVID duty. “This is a prime time for us to learn like for me from General Surgery wing, performing and learning surgeries and specialising in it is critical. But I am unable to do so. We have to acquire the skill and apply the same on people. The Government, instead of playing with our lives, could have taken a balanced approach with COVID duty and non-COVID time. But here it is just COVID duty and nothing else,” Ronak says.
“The funny part here is that the PGs are working in COVID wards but not learning anything. But they continue to pay the fees despite no learning at all. Here in a Government institution, we pay up to Rs. 2 lakh, for zero learning. The least the Government can do is to waive off the fees as there is no learning happening. 2020 was washed out in all our careers and now it looks like 2021 too is a total wash out,” he says.
Many medical terms added to common man’s lingo
Cytokine storm, happy hypoxia, pandemic, immunocompromised, comorbidities…
Most of the COVID patients are emotional and it is too difficult to bring them to their normal state. A lot of counselling, reassuring words and gentle advises are required. “We don’t just treat patients. We offer mental support too,” says Dr. U. Ajay Sharma, who is pursuing his PG in Physiology. Hailing from Hosadurga in Chitradurga District, he came to Mysuru in 2017 and joined MMC&RI.
Thanks to COVID, last year the common man learnt terms like PPE kits, social distancing, pandemic, quarantine, flattening the curve, containment, herd immunity, isolation and immunocompromised. This year, the common man is learning terms like cytokine storm, happy hypoxia as they are causing many fatalities.
“Recently, increasing studies indicate that ‘cytokine storm’ is contributing to many COVID-19 deaths. Cytokines are basically proteins that are produced by different types of body cells. They help in many functions of the body which include immunity and inflammatory responses. However, things can go terribly wrong if the body releases too much cytokine. It can trigger a reaction that can turn fatal. The phenomenon where the body releases too much cytokine is called cytokine storm,” he explains.
Studies show that many sick patients with COVID-19 have their blood flowing with high levels of immune system proteins which are nothing but cytokines. The intensity of the cytokine storm that COVID triggers is quite strong and this is leading to more mortality, Dr. Sharma opines.
Another condition which is causing death is ‘happy hypoxia’. Hypoxia refers to very low oxygen levels in the blood. The normal oxygen saturation in the bloodstream of a healthy person is above 95 percent but COVID-19 patients display dangerous declines of as less as 40 percent.
“While hypoxia is a warning signal for imminent failure of vital body organs like the kidneys, brain, heart and is usually accompanied by prominent breathlessness, ‘happy hypoxia’ does not prompt any such obvious external signs. As a result, in the initial stages of sickness, the COVID-19 patient, on the outside, appears to be alright and ‘happy’. That means the patient does not even realise that his oxygen levels are low. Result: Death,” Dr. Sharma says.
A vicious cycle
COVID deaths are caused by a vicious cycle that starts with late detection leading to panic and breathlessness and they are taken around by relatives in search of hospital beds, oxygen and ICU. If they don’t get it, patients further panic and the death-chances increase. “Even after admission some die as they get unnecessarily panicky even if the neighbouring bed patients feel breathless. In such cases, SPO2 levels drop. Moreover, COVID patients feel lonely and battle without any loved ones nearby,” he explains.
Dr. Sharma’s wife Dr. P. Tejaswini too is doing COVID duty at a private Ayurveda Hospital in Hebbal. “She is an Ayurveda doctor and we both are in the critical work. We take absolute precautions and only now I am put on routine office work. I worked for almost a year at COVID Care Centre set up at KSOU Academic Bhavan near Mandakalli that has a capacity of over 600 patients. We had to put in six to eight hours in day shift and 12 hours in nights. We used to eat to our fill while reporting to duty as there is no chance of eating before the shift ended. After duty, we used to change, bathe and only then eat or drink,” Dr. Sharma reveals.
COVID pandemic has given a new meaning, purpose
‘Social stigma attached to disease kills patient’s confidence’
If PG doctors in Mysuru are serving relentlessly fighting their battles with certain illogical decisions by the powers that be, here is a doctor — having her roots in Mysuru — who has come from abroad and has been serving her hometown without any expectations. Her educational institution on the foreign shore (name withheld on request) has been closed due to COVID-19 pandemic and virus-induced lockdown.
Meet Dr. Aisiri Shivakumar, who has been putting in long hours of the day at COVID Mitra Centre established at Seth Mohandas Tulsidas Hospital on JLB Road. She has completed her final year at a medical college abroad and is waiting to write her exams which have been delayed by the virus outbreak. Meanwhile, she has volunteered to serve at COVID Mitra.
Dr. Aisiri is the daughter of Shivakumar-Geetha couple, residents of Kuvempunagar. Participating in online classes with her institution simultaneously, she is also doubling up as a medical professional at COVID Mitra treating patients, examining their condition and also giving medical advice that suits the condition of the patient. She also fills confidence in patients who would have lost all hopes of recovery with the social stigma attached to the disease and Aisiri says it is a tough task indeed.
“I had to come back to Mysuru as lockdown was announced and was taking regular online classes. I was also wishing to serve my home-city and save at least some patients at a place that has given me so much. The opportunity came when Mysuru City Corporation called for volunteers. My friend Sumanth told me about that and I did not look back,” explains Aisiri.
She went to MCC Office and enrolled herself as a volunteer-doctor. “I obtained basic training of functioning in a COVID Mitra and being a doctor was an added advantage and I was posted in Tulsidas Hospital. I learnt many things from senior and experienced doctors,” she says.
Emotional bond with patients
Mentioning how it is to be a doctor on foreign shores, Aisiri says, “Abroad there is a staccato relationship between patients and doctors like where patients are just treated as a person who has a particular disease and the doctor is bringing out the patients from the disease. Here in India, doctors have an emotional connect with the patients and are more humane to feelings where doctors turn friends, counsellors and family advisers. This bond helps patients recover faster. A few good words from the doctor can comfort and boost the confidence of the patient and he can feel much better and recover fast too,” she opines.
On any emotional moments in her volunteer service, Aisiri narrates an incident where an elderly person was brought to the COVID Mitra. “He had breathing issues and was brought dead. But I had to convey the news to his loved ones and I was disturbed. Seeing my plight, a senior doctor conveyed the news to the family. Later I was counselled and reassured and after sometime, I was back on track,” she reveals.
A good dancer
Aisiri is a versatile dancer and she excels in Bharathanatyam and Kathak. While Vidushi Sheela Sridhar is her Bharathanatyam guru, Vidushi Nandini Eshwar is her Kathak guru. Though a passionate dancer, she had to follow the footsteps of her medical-professional-sisters Dr. Deepika and Aishwarya. “Though I was forced into this, I love this profession. And COVID pandemic has given a new meaning to my profession. After my abroad education I will return to Mysuru to serve the society here,” she says with an infectious smile.