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RESIDENT CORNER
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 347-349

Throwback to when it all started


Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission19-Mar-2021
Date of Decision25-Apr-2021
Date of Acceptance30-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Alok K Shetty
Department of Medical Oncology, Office 11th Floor, Homi Bhabha Block, Tata Memorial Hospital, Ernest Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_84_21

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How to cite this article:
Shetty AK. Throwback to when it all started. Cancer Res Stat Treat 2021;4:347-9

How to cite this URL:
Shetty AK. Throwback to when it all started. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Oct 22];4:347-9. Available from: https://www.crstonline.com/text.asp?2021/4/2/347/320163



As the country is reeling from the second wave of the coronavirus disease 2019 (COVID-19) pandemic, I flipped the pages of my diary back to the days when I had my first brush with the virus. It feels like yesterday, but in reality, it has been a year since then.


  April 19TH, 2020 Top


The world is going through unprecedented times, and so are the centers of health care. Working in a tertiary care cancer center that caters to a large number of patients in the country and experiences heavy patient footfalls everyday despite the travel barriers, it was inevitable that we would make contact with a “COVID-positive patient” sooner or later. For how long could we hold things at bay? Our center had seen three cases so far, and either by sheer luck or misfortune, I have come in contact with two of them, which means statistically, I have made contact with 66.7% of the cases. Seven months into my oncology residency, I have come to realize that oncologists are obsessed with statistics! Attending elaborate webinars on COVID-19 and its implications on oncology practice may be interesting, but it is not as exciting as diagnosing and managing patients affected with COVID-19 in the real world. I feel it prudent to pen down my experiences, so that the future me (if I survive the pandemic, that is) may one day sit down and gloat over the glories of the past.


  The Second COVID-19 Case at the Tata Memorial Hospital–One Night at the Isolation Ward Top


It was just the beginning of another “evening ward rounds” at 6 pm, as I started collecting the investigations of my patients. I was disappointed to note that the counts of my patient with acute myeloid leukemia were yet to rise, despite it being day 21 of induction. I was elated that I had sufficiently replaced the potassium in another patient of mine with acute lymphoblastic leukemia who had pneumonia and was on an antibiotic called colistin. But today was slightly different and I had to fasten my pace. I was posted in the isolation ward tonight, a ward created for testing and isolating patients who were suspected to be infected with the deadly coronavirus. I could feel a sense of excitement. Having braved enemies such as Mycobacterium tuberculosis, human immunodeficiency virus, hepatitis C virus, and influenza A virus subtype H1N1, the novel coronavirus somehow failed to instill any fear. So why was I excited? I had been a general physician not so long ago and had worked at the forefront, dealing with many deadly infectious diseases. But as I moved into specializing in cancer care, my role in this pandemic became somewhat restricted. Hence, any opportunity to be a part of the greater activity enthralled me. I quickened my pace as I walked through my hemato-oncology ward talking to and examining my patients, altering their ongoing treatment as per need, counseling them about the treatment plan, and informing some of them about how they were just 2–3 months away from going home. I threw in a joke here and there to alleviate their pain and suffering. When not overburdened myself and whenever necessary, I would try to cheer my patients up, an art I had picked up from my mentor. When some of my patients complained to me about being nauseated by the sight of food, I would humorously tell them that the simplest solution to this problem was to eat their food blindfolded, as the other hemisphere of my brain reminded me to escalate their antiemetic regimen.

All the while, my mind kept track of the time. It was 7 pm, and my shift was about to start at around 8 pm. There was one child in the isolation ward who was stable and whose swab report was awaited. So far, there was no news of any other patient being shifted to the isolation ward. I continued my work.

At 8 pm, I had only one more patient to work up. Just as I thought that I would quickly finish the workup for this patient before proceeding to the isolation ward, a message flashed on my cellphone. A patient was being shifted to the isolation ward; her swab was to be taken, and she was to be monitored. I apologetically requested my colleague to take a look at the new admission, as I rushed to the cafeteria and quickly gobbled up some food. One of my extremely concerned professors had called me an hour ago, instructing me strictly to eat something before stepping into the isolation ward, since she was well aware that as residents, we had mastered the art of fasting and working relentlessly. My heart pounded as I raced up the stairs and reached the entrance of the ward, only to realize that the patient was yet to be shifted. I waited at the adjacent nursing counter, checking on the previous patients' reports, reading the electronic medical records of the patient to be shifted, and revising the notes on personal protective equipment (PPE) and how to take a swab. Our institute and consultants had extensively researched the necessary measures and precautions to be taken when managing patients infected with COVID-19 and spread relevant scientific information through various channels.

The patient was shifted into the ward in a jiffy, with me barely realizing it. The shifting team left, and the nurse was already in to receive the patient. No amount of preparation can make one ready for the actual moment. As I stepped into the isolation ward, the silence was deafening. I was staring down the corridor with around 10 rooms on each side. The suspects were housed in the distant most rooms, while the rooms proximal to the entrance were for changing and storage of PPE kits. There were only three health-care personnel in the isolation ward-I, the nurse, and the ward attender.

I quickly donned the PPE, stepped out into the corridor, and walked down. I enquired about the kid whose report was awaited. “No complaints. The vitals are stable,” declared the nurse. I peeped into the kid's room and found him sleeping peacefully; I decided to leave him undisturbed.

In my opinion, it is easier to intubate a breathless patient than to console a crying kid.

I then went into the newly admitted patient's room and greeted her. She was a young lady, around 23 years old. Despite having gone through her records, I inquired about her symptoms. She was from Mizoram and had been living in Mumbai for the past 2 months. She had a family history of breast cancer and was herself diagnosed with it 2 months ago, after she had noticed a lump in her breast. She had received three cycles of neoadjuvant chemotherapy, and the fourth was withheld in the wake of the pandemic. Considering the curative potential of the surgery and the risk of postponing it, she was planned for surgery and admitted to the hospital a day before surgery.

On admission, she was noted to be febrile, and after discussions, the treating unit had decided to test her for COVID-19. She confessed to me that she had nasal discharge. This alarmed me as it was the single most important factor that could increase the probability of her testing positive. I deftly performed a physical examination. “Chest is clear,” I declared, as my brain noted bilateral vesicular breath sounds. I told her why she was shifted to the isolation ward and briefed her about the procedure that we would perform. I added that we should hope for the best. She thanked me and consented with a nod. I then requested the nurse to bring in the swabs for testing. In the interim, as I waited with her, I saw that she was petrified. Were there tears in her eyes, or was I imagining it? I had read numerous accounts of patients across the world who, when afflicted by the virus were tensed and thanked their health-care providers for their support and concern. I realized that it was my turn. I tried to pacify her and engaged her in some conversation. She told me that she worked in a church back home, and I suddenly realized that it was the Easter weekend; I inquired about it. “Yes, it's Easter, The rising of Jesus Christ from the dead,” she said in a monotone.

This put me in a philosophical frenzy. Was God testing her? She was someone who had led a life dedicated to prayer and was probably already traumatized with the diagnosis of cancer at a young age. Now she would have to go through more trauma. “Why her?” my soul asked. A tough question to answer, isn't it? “Why me? Why should I be the risk-taker?” I had the option to be elsewhere, probably leading a relatively more comfortable life. So why was I here? Because I made a choice. “It's our choices, Harry, that show us who we truly are,” Dumbledore echoed in my mind.

My reverie was broken by the nurse entering the room. I quickly muttered a prayer to the power that oversees us, that I not be the portender of doom to this young lady. I filled in a form that the nurse provided, with inputs from the patient. I then put the patient in position and collected the nasopharyngeal swab. Collecting the oropharyngeal swab needed a little more skill. As I brushed the swab over the tonsils and the back of the throat and removed it, the patient coughed – an inevitable reaction. The gag reflex, my brain reminded me. I put the swabs in the media and sent them to the microbiology laboratory for testing. I suggested that she sleep through the night and hope for the best.

All that was left now was to wait. I sat in front of a computer and quickly read through an article on high-dose methotrexate infusions. My forehead ached from the shield, my nose ached from the mask, my stomach grumbled, and only my bladder seemed to be cooperating with the stress! My nose, with its deviated nasal septum, was not prepared for this hypoxic insult and screamed for air, but I had nothing to pacify it with.

As the strain worsened, I decided to take some rest. I peeped into the kid's room and found him still happily sleeping. I went into a room and lay down on a bare bed and dozed off reminding the nurse to wake me up at regular intervals and definitely at 6 am, when the reports would be out. She woke me up at regular intervals and informed about the vitals of both the patients. Her concern and care were genuine and extremely appreciable. We had to give the lady paracetamol when she had another fever spike. We decided against a blood culture at that moment. The kid had a spike of fever too but was otherwise stable. We decided to send a sample for blood culture tests and continue his antibiotics. We gave him paracetamol for some symptomatic relief.

I woke up for good at 6 am and called the laboratory. Much to my chagrin, the technicians informed me that they were not authorized to provide reports over the phone.

“Protocol!” – I exclaimed to calm myself down. The nurse stepped in behind me and whispered, “Doctor, she has mostly tested positive. I have already received a lot of calls from my nursing superiors.” No amount of excitement can brace one for the wave of fear that hits at that moment – a lump in the throat, a missed heartbeat, and that sinking feeling in the stomach. Were we safe? “Yes, we were,” said one hemisphere of my brain as it tried to calm the other. I was cut off from my cellphone and was ignorant of the goings-on in the world outside. My first reaction was to call up a good friend, who unfortunately was still in deep sleep and had not received the news yet.

I then quickly called some of the consultants who were in charge of the isolation ward, who broke the news to me. We discussed other relevant issues about the patients too. I thanked them, put the receiver back down, took a deep breath, and stood up. The play must go on.

I was told that a senior personnel would counsel the patient regarding her diagnosis, which meant my prayers were at least partially answered.

Meanwhile, there was some problem with the kid's sample, necessitating repeat sampling, and another patient was about to be shifted into the isolation ward. At this moment, I was physically exhausted (despite my disturbed sleep), hungry, and a bit anxious. Much to my relief, my shift was over, and my colleague came in on time and rescued the day. I doffed the elaborate costume, showered, and stepped out with a sigh of relief. The marks stayed put on my forehead and nose. In the meantime, hell had broken loose in the outside world. More stringent precautions, more screening measures and the flag bearers of the institute were putting in their best efforts to keep the enemy at bay.

However, the enemy was here; it had breached our forts, invaded our territory, and taken hold of what we sought to protect the most – our patients. It was only a matter of time before one among our ranks began to show symptoms, and that is when the battle would get tougher.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.






 

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