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Inside a COVID ICU: For Doctors & Nurses, No Time for a Breather

"To lose so many because you have inadequate beds, ventilators, it is very disheartening for the young residents."

Updated
Coronavirus
4 min read

Producer: Vaishali Sood Camera: Athar Rather, Editor: Prashant Chauhan

"For six weeks, no break. It's been difficult, for everybody, it's been difficult," says Dr Sumit Ray.

He's a critical care specialist and the medical superintendent at Delhi's Holy Family Hospital. The Quint's team stepped into his ICU on 12 May, the day Delhi had less than 12,000 new cases. For the first time in over a brutal six weeks, the emergency room at the usually very busy hospital was nearly empty. Patients wheeled in were getting beds and immediate care.

Those who required ICU beds though, were being triaged to other hospitals nearby.

As waves ebb, the pressure shifts from emergency rooms to the Intensive Care Units. Those who came in weeks ago have taken a turn for the worse, or those who were wheeled in after going from hospital to hospital, already in severe condition, are shifted directly to an ICU.

The number of new cases have gone down. It will be a while before the doctors and nurses of the ICUs get a moment to breathe. And to grapple with what they've witnessed.
<div class="paragraphs"><p>A packed ICU ward at Holy Family Hospital</p></div>

A packed ICU ward at Holy Family Hospital

(Photo: Athar Rather) 

The Brutal Weeks of the 2nd Wave

"We have 66 patients at the ICU right now. Our bed capacity is 56. There's no place, no slots that are free, no corner to put a trolley in," Dr Ray tells us.

In normal times, the ICU had 48 beds, with 40 patients occupying them. Not all of them were on ventilators. Now it's different. There are patients elsewhere in the hospital who should have been in the ICU, but there's no space. They've converted other high dependency units into critical care setups.

<div class="paragraphs"><p>Dr Sumit Ray pours over the chart of a 31-year-old patient with his team.&nbsp;</p></div>

Dr Sumit Ray pours over the chart of a 31-year-old patient with his team. 

(Photo: Athar Rather) 

"No one sits. Through the shift, no one sits. They are standing or there is a sudden rush or movement of patients and they are constantly on their toes," says Dr Ray. These shifts stretch beyond the already long hours.

The patients are more serious this time. There has to be a constant vigil. Dr Ray says working in an ICU is an intense job, and the intellectual energy required to make constant decisions is taxing. His nurses and staff are knackered.

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'Worried About the Mental Health Impact on the Staff'

Surges will go down, but Dr Ray worries about the mental health impact the pandemic will have on his largely young staff.

"You see, specialities attract certain personalities. Critical care doctors are adrenaline junkies. But this time, the outcomes have been poorer, and for reason beyond their control. They say, doctor, we tried our best but we still have such poor outcomes. We have to constantly boost moral."
Dr Sumit Ray, critical care specialist, Holy Family Hospital, Delhi
<div class="paragraphs"><p>Nurse Tenzing helps a patient do a video call with his family.&nbsp;</p></div>

Nurse Tenzing helps a patient do a video call with his family. 

(Photo: Athar Rather) 

Nurse Tenzing is a 10-year veteran at this ICU. We see her helping some distressed patients get in touch with their loved ones via video calls. Some of the family members struggle with technology, as she calmly walks them through it.

There's no meeting hours, the physical touch of a loved one, during a pandemic. It's the staff that is family.

She tells us it's been hectic.

"Initially there was lack of oxygen, ventilators. It was very distressing. So many young people dying, our age people dying, it's tough. You try your best, but still you lose some."
Tenzing, ICU Nurse, Holy Family Hospital

Dr Ray says in terms of percentage, the outcomes for younger patients is more or less the same, but the sheer volumes is overwhelming. "There is always a selection bias in triaging. There's a sick patient who need critical care, a selection bias comes in, a younger patient gets it. There is evidence for it, there are guidelines for it, but it's hard," he tells us.

<div class="paragraphs"><p>A patient in distress gets attention.</p></div>

A patient in distress gets attention.

(Photo: Athar Rather) 

A patient goes into distress while we wait, and the staff gets on with their job of saving lives.

The hospital's director, Father George, gets emotional when talking about what his medical staff has endured. He says now the oxygen supply and other issues are sorted. But even when things were out of control, his staff did not give up.

"I call them my angels. No matter what was going on, long hours of shifts, illness, constant patient care, they always had a smile on their face. They never complained."
Reverend Father George, Director, Holy Family Hospital

There will be time to regroup, to prepare for surges, to look at numbers and examine deaths data, to procure more equipment, but the hospital is acutely aware that trained medical staff will not be easy to come by.

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