Directly from the frontlines of COVID pandemic – A three-part diary: Guest Author Bidur Mukherjee, DPT
With the current ongoing situation with COVID-19, Physical Therapist Bidur Mukherjee is sharing his real-life experience at the frontlines of managing patient care at the local hospital in Las Vegas.
March 20, 2020, Directly from the frontlines (Part 1)
I am a healthcare worker in a US hospital directly involved in the care of patients including those with COVID-19 positive. There are hundreds of thousands of workers like me. In the following few passages, let me share some of my experiences with you.
Hospitals are never the most pleasant place to be in. However, these days there is palpable tension as you enter. There is an eerie calm. No visitors, no elective surgeries, and then there is the omnipresent pungent smell from the extra use of cleaning and disinfecting products. Yesterday, I looked up my schedule and sure enough, I had a few COVID patients to see. Hospitals have mostly cohort these patients to a particular floor (“the zone”). Before I go any further a bit of background information about my role. Physical and Occupational Therapists (PT/OT) have the primary responsibility of improving patient’s physical function so that they can achieve their maximum level of independence. PTs and OTs are responsible for mobilizing patients: starting from getting up in a chair out of bed to walking the hallways. Unfortunately, not everyone will recover enough to go back to the community walking and living in their own homes. There are those who will require equipment (walker, commode, prosthetics, etc.), some families will need the training to care for the sick and there will be some for whom the appropriate discharge destination will, for example, a rehabilitation unit, a nursing home, a group home, assisted living and sometimes sadly, a homeless shelter. Therapists recommend a discharge plan to other team members such as case managers, nurses, and physicians.
With some trepidation, I walked into “the zone”. The shortage of masks, gowns, goggles particularly N-95 respirator masks (called PPE – personal protective equipment) is to be seen to be believed. America – the land of plenty – out of essential supplies, really?? It would be no exaggeration to say that war zone rules apply at this time. And this does bring out the best and worst hidden in human character. There are some who feel let down by their administrators and there are others who are going out of their way to help each other. Mostly, we realize that hospitals have protocols and practices for all foreseeable disasters. What about the unforeseeable? To be fair to everyone neither this nation or its hospitals could have been well prepared for a global pandemic of this scale. I am about to describe a short encounter below from yesterday. Needless to say, there were many other patients to see before the end of the day.
I and my OT co-worker walked into the room. John (name changed), a stocky man in his late 50s stated he was feeling a little better. Thankfully, his cough was much less than before and his fever had gone. We helped him to stand up with a walker. The combination of his pre-existing conditions and the COVID virus had left him weak and he had a tough time keeping his knees straight against gravity. We helped him walk by the side of the bed a few steps. After that we had him complete a few simple exercises until he was visibly somewhat exhausted. We got him all cleaned up and left him positioned comfortably in his bed spending a total of about half an hour. As I closed the door behind me, I heard him say, “Thank you”. I said to myself, “No worries, John. We will be here for you, as long as it takes”.
As I return to work today, driving past the American flag still fluttering proudly in the front porch of our hospital here are some of my thoughts:
To those who are hoarding food and toilet paper well beyond their reasonable needs: maybe it is time to be more considerate of your neighbors.
To those who are stocking up on ammunition and guns, I want to remind them that these are no protection against a virus. They will never help save a life.
To the media: please bring facts to the people and leave the criticism for later. The blame game can wait. Right now we need messages of hope and positivity.
To the public at large, my message is to remember these famous lines: “And this be our motto: ‘In God is our trust.’ And the Star-Spangled Banner in triumph shall wave. O’er the land of the free and the home of the brave!”
Take common-sense precautions, friends. However, go about your normal lives without fear. This too shall pass.
April 9 Directly From the Frontlines Part 2
Ominous dark clouds hung low across the valley setting a perfectly sickening backdrop for the surreal drama unfolding in the lives of millions. It has been three weeks since I wrote the first part of this saga. A lot has changed as Americans adjust to the “new normal”.
Since then, cases have multiplied a hundredfold and thousands have fallen victim to the virus. A city so known for its glitter and glam is at a standstill with countless jobs lost and a looming uncertain future. The flag mentioned earlier is at half-mast today. In cruel contrast, however, the chirping of birds has never been louder.
The morning has come, sleep or no sleep, it is time for me as a healthcare worker to stand in line waiting to enter the hospital. I get my temperature checked, declare that yes I may have been “exposed” and I put on a mask – all in a tent outside the hospital. Masks once scorned upon (“take that dirty thing off your face”) is ubiquitous now in healthcare settings. All of this was unimaginable a month ago but is a sad part of life today.
Trudging through hallways that feel like I have been gaining in length every day, I work my way to the office and take a look at the schedule. No. It is not me today. Another co-worker got the COVID schedule today. Very selfishly, I breathe a sigh of relief. Expressions hidden behind masks, it still is clear from the body language who among us got that dreaded list. We pretend business as usual when it is anything but that.
“Miss Jane, I am your physical therapist. I am here to get you out of bed and get you stronger. Can we do that now?” She nodded approval. Jane is suffering from sepsis and multi-organ failure and, hospitalized for 3 weeks now and barely able to move or speak at all. Since no visitors are allowed this has been especially hard on patients and their loved ones. Her walls were full of pasted phone/email messages from her children, grandchildren, and friends. In her frail condition, she did not have the ability to read them. I asked if I could read a few to her while working on her sitting balance. This time I got a very emphatic “yes”. The common refrain in these letters was obviously we miss you and get well soon. The third letter said, “Mom, I make the best-scalloped potatoes and I am dying to make some for you soon”. I glanced at the possibly permanent PEG tube (surgically inserted tube in the stomach for feeding) and felt a lump in my throat.
Ashley a thin woman in her late fifties who is recovering from a stroke was next. I trained her with a hemi walker how to walk again. She was dragging her right foot at times but was a quick learner. She was expecting to see her husband in the parking lot from the window in her room. Her husband had driven 60 miles and brought her some of her personal items (deposited to security downstairs) which were left behind during the emergency visit to the hospital. Still slurring in her speech, she could not give him proper directions over the phone. I helped, “Gil, look up from where you are- the third window to the right on the second floor.” “Do you see her leaning against the window trying to wave?” It was a poignant sight. They spoke over the phone and said their byes with tears flowing freely.
At shift change today local police department sends 30 police cars for a parade. They meandered around our parking lot with flashing lights and sirens blaring honoring the healthcare workers. Nurses, housekeeping staff, physicians, dietary staff, managers all acknowledged and waved back. Videos were taken for social media. It was a touching moment.
At the end of the day, washing my already chafed hands one last time, I felt a twinge of guilt. No. A hero I am not. Folks, I have often thought of a career change. I am sorry not to have paid enough attention to the profound impact simple acts of kindness were having on another human life. I have often failed to recognize the therapy I deliver is therapeutic to me as well.
May 14, 2020, Directly from the Frontlines (Part 3)
It has been eight weeks since I wrote the first part of this saga. Readers beware, this time you may discern a tone of exasperation and urgency. If you are not ready for a surgical reality check from the frontlines please drop this right now.
Ready? Here is some myth-busting and a call to action.
Myth #1: The worst is over.
Reality check #1. No evidence of this from the perspective of healthcare workers. It may well be that the worst is yet to come. Life has stopped at a traffic signal for many who are desperately hoping to see the green light. However, in the short term, you are only going to see red and yellow. If green ever returns, its shade will be very different. Consider this: 9/11 changed our lives forever. In terms of deaths, we are still repeating a 9/11every two days.
Myth #2: It is like the Flu.
Reality check #2. Some of my co-workers got infected and did suffer from COVID-19. They were young and from an athletic background. They went through one of the most difficult times of their lives. This is a serious, serious disease. Unlike the flu, it presents very differently from person to person. Doctors and our immune systems have no clue how to battle this effectively. Many healthcare workers across the country have already died, or have had to deal with living hell. Unfortunately, there is more to come.
Myth #3: A vaccine or cure is around the corner.
Reality check #3 Like everyone else, I like to be optimistic. However, this is not like trying to hasten a software rollout. Biological systems do not work that way. Things take time. You cannot explain your urgency to a microbial culture in a petri dish. There are safety measures in place to make sure that vaccines/drugs are safe because lessons of history have been learned. The consequence of not adhering to standards is disastrous. Ever heard of the thalidomide catastrophe? Common cold has been around since eternity and there is no vaccine still. Many people get the annual flu vaccine but it is not effective enough for some years.
OK, enough bad news. We have to learn to live with this menace. Now here is where all of us as Americans can make a difference and support frontline workers like me.
- National strategy. Having systems and policies in place makes a huge difference. We need a plan that goes into the nitty-gritty of managing this crisis over the next couple of years and also for future pandemics. This should be done very transparently so people can feel confident in their daily lives. If there is a strategy currently it has not been widely publicized. The following points should be part of it.
- Massive local production of PPE Global supply chain is going to be unreliable for a while. So, what we need is industrial-scale local manufacturing. We need a minimum 2-year stockpile of the head to toe protective equipment. Healthcare workers need to feel protected in doing their jobs. We are failing abysmally in this regard. PPE is being rationed country-wide as though it was worth its weight in gold!
- Ramp up testing This virus can have a very long incubation period. Healthcare workers unknowingly may be spreading the virus because they are asymptomatic. Temperature checks and masks at hospital entrances are not enough. All essential workers should be tested for COVID every 2 weeks even if not sick. Go to coronavirus.gov today. It is still not recommending you to get tested even if you were involved in COVID care without proper protection. Does this not defy common sense?
- Stricter infection control measures Physicians, therapists, nurses treat patients with HIV, TB, Hepatitis B all the time. How many times have you heard of healthcare workers contracting these diseases? Very rarely, correct? That is because hospitals maintain strict infection control standards. What is happening now is just the opposite. Go to CDC.gov. It talks about how PPE should be saved and reused. Yes, you read it right. In the midst of a pandemic, they want more lenient standards. Wonder why healthcare workers are dying?
- Take care of healthcare workers These are your own people. While it is morale-boosting to call them heroes, and it is exciting to have Thunderbirds giving a spectacular display; our responsibility does not end there. Like in a war zone, there will be attrition and mental health issues among them that need addressing. If a worker falls sick or dies of COVID, their families should be taken care of in the same manner as loved ones of injured or fallen soldiers. These people were not injured in an ordinary car accident; they were doing a risky job for the benefit of society at large.
This is straight from the heart. Folks, please heed scientific advice. Science and innovations are what brought glory to this country and it is our only chance to fight this pandemic. Some countries have done a far better job of handling this crisis. Let us have the humility to learn from them. If this is not done, unfortunately, there is a lurking invisible enemy just waiting for an opportunity to strike at anyone in its path. If not stopped, it will claim the lives of people you know hitting ever closer and closer home.
Las Vegas resident Bidur Mukherjee is a Physical Therapist with 27 years of professional experience and is currently working at a local hospital in Las Vegas.
Disclaimer: Names, situations modified in compliance with regulations.
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