|Year : 2020 | Volume
| Issue : 3 | Page : 427-428
Doctoring in the time of COVID-19 – Lessons learned
Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
|Date of Submission||25-Jul-2020|
|Date of Decision||29-Jul-2020|
|Date of Acceptance||30-Jul-2020|
|Date of Web Publication||19-Sep-2020|
Department of Medical Oncology, Kasturba Medical College,Manipal 576104. Karnataka
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mailankody S. Doctoring in the time of COVID-19 – Lessons learned. Cancer Res Stat Treat 2020;3:427-8
“How far can you support a man climbing a coconut tree?
Only as far as hands can reach.”
I feel this is the current situation for health-care workers trying to protect themselves, their families, and their patients from COVID-19.
In early January 2020, I complacently watched this news bulletin on the “Wuhan epidemic;” I was safe in Kerala, fully engrossed in my 4-months old son. “Coronavirus cannot survive the Indian weather,” and other such predictions comforted me.
Then gradually, COVID-19 came closer, and before I could realize it, my son turned 6-months old. It was time for me to rejoin work after maternity leave, and the COVID-19 pandemic had reached India.
“Let me join after this settles down,” I requested the head of my department. Being the understanding person that he is, he immediately agreed that it was not safe to travel during this time.
However, 2 months into the lockdown, there was a gentle nudge from the department reminding me that I would have to travel some time and rejoin the department.
I too felt that my life had been put on hold. As my initial hope that the community spread of COVID-19 would not occur in India did not materialize, I realized that I would have to learn to live and cope with the pandemic.
So after a lot of discussions, a multitude of e-mails to and from the department/institute, application for a permit for interstate travel, choosing the drivers (“Hello, you haven't picked up or dropped anyone from the airport, no?”), and preparing for a long journey, we walked across the Kerala–Karnataka border to reach my place of work. We had to walk to avoid the “state” drivers being quarantined.
After some hassle regarding “Institutional” quarantine, I managed to complete 14 days of quarantine and join back work after 10 months of professional inactivity.
My entry into the masked world was at the peak of the pandemic in my area. I had carefully watched the instruction videos for the use of personal protective equipment (PPE). Again, after fine-tuning a lot of suggestions from other working mothers, I established my work routine during these challenging times. It included commuting to the hospital (preferably walking); doing rounds and outpatient department (OPD) with closed shoes/socks, cap, mask, gloves, and face shield; change of dress; commuting back home, a quick full body shower, and feeding the baby. This travel-dress change-PPE-OPD rigmarole was repeated in the afternoon and evening. I examined patients only when necessary and took all precautions around them. An oncologist, I feel, has to be extra-cautious because patients with cancer are very vulnerable to infection and associated morbidity.
Was this working out? Yes, slowly, I got used to seeing only the eyes and foreheads of the patients and the people around me. After a lot of separation anxiety and sleepless nights, my son was also getting used to me being away at work during the daytime, but this was not to last long. Had we become complacent? Unfortunately, both my husband and I got exposed to the virus from the most unexpected source – an asymptomatic colleague. Later, we would try to recreate the sequence of events that led to our “exposure” to the ID consultant – the exact duration of “off mask” time, the location of the encounter, etc. Nevertheless, a “breach of PPE” had occurred. After all the care that we had taken around patients, we were exposed to COVID-19 while we were with a friend!
“High-risk contact,” “low-risk contact,” “unmasked,” and “breach of PPE;” a lot of words were bandied about as the senior consultants decided our immediate future. They were kind to us as they realized that it could easily have happened to them too. Finally, they decided to home quarantine us for 14 days.
“Perhaps you could feed him wearing an N95 mask,” my consultant suggested, knowing that I was lactating.
I tried hard, but my son, who had recently become acquainted with “peekaboo” loved the ritual of immediately pulling away my N95 and “uncovering” my face, giggling happily. I decided that there was more risk with him touching my N95 mask, so I decided to feed him as such.
I was experienced at living in quarantine by now – the anxiety, the wait for the test reports, and the feeling of being “locked” down.
This was the awful situation that I had tried very hard to prevent. My son got exposed to the virus because of me. Was the so-called PPE breach bad luck or irresponsibility? Was it just human nature to relax momentarily with a friend? The problem was that I had dropped my guard and did not associate a casual meet with such a huge risk, and that, they say, is one of the reasons why COVID-19 spreads among health-care workers. Infection often spreads through chats, tea breaks, and case discussions in the corridors with colleagues, when the mask is pulled down for a clearer and faster communication.
Nightmarish visions of the isolation wards with strangers caring for my son, while I was on treatment at the hospital or worse, both of us requiring ventilation, etc., ran through my mind as I grappled with my unwarranted guilt. My emotions swung between fear and a firm belief that our exposure had actually been very minimal.
Eight days had passed! There were no symptoms, and my swab results came out negative. I could now cover the 'distance' between me and my son! Not that I had been able to maintain distance with him anyway! But, this was an official rapprochement.
A human being is a social animal, but being an oncologist and a mother comes with its own set of responsibilities. My next stint at working and social “interactions” will involve a lot more care with PPE, as it is only by protecting myself that I can protect my family and my patients.
It is human nature to err and forget; I hope that I remember the lessons I learned the hard way!
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Srinivasan K. Climbing a coconut tree. In: Rao SR, editor. Perceptions. Chennai: Orient Longman Private Limited; 1988. p. 9.