A Nurse’s Life

IT WAS AT 1.30 PM when Judy David reported for her shift as the evening duty nurse at the newly converted Operation Theatre (OT) of the All India Institute of Medical Sciences (AIIMS) that she got to know that she would have to assist a Covid-19 patient in delivery. David was tense. She had been working as a nurse in the psychiatry department and had not assisted in a Caesarian delivery for a long time. At AIIMS, this was the first case in the OPD-turned-labour OT dedicated to Covid-19 cases.

She went into the OT to check if all the items were in place. “Our worry was not that we were dealing with a Covid-19 patient, but that the procedure should be completed without any problem.” She then went through the 30-minute donning protocol of the personal protective equipment (PPE) kit—shoe covers, gown, mask, gloves. Armoured from head to toe, she felt she might faint from the heat and dehydration. The air conditioner and fans were switched off in fear of the virus spreading. She could faintly hear the patient, who had contracted the infection from her husband, a resident doctor at AIIMS, repeatedly say: “Don’t leave me and go.”

After the delivery, David helped her feed the baby boy. “I think she was happy. But because she was infected, she was afraid and kept fearing everyone will leave her.” The entire process had taken four hours. It was only at 8 pm, after the others in the team left, that David got out of the PPE kit, again following protocol, this time, of doffing. She had a bath in the dedicated area and made a call to her roommates, also nurses, asking if she should return as she had attended to a Covid-19 patient. They told her to come back. She went to her room and had another bath, changed clothes and helped her friends in preparing dinner.

But David, 24, is haunted by the fear of infecting others. She has stopped going out to the shop to buy provisions. Her friends do that. She walks from the hospital to her room, which is behind the AIIMS complex. On the eighth day after contact with the Covid-19 patient, she has to get tested for the SARS-CoV-2 virus. “After the delivery, a lot of people congratulated me. My mother calls up every day from Kerala to ask if I am feeling any symptoms of coronavirus.” She is still posted at the special OT for coronavirus-infected women in labour.

The AIIMS trauma centre and burns and plastic surgery buildings have been dedicated to Covid-19 patients. David, who has been working at AIIMS for one-and-a-half years, was initially asked to move there but since there was enough staff, she was posted in coronavirus screening, done for AIIMS staff exposed to infected patients. When they asked her if she was willing to move to the labour room for Covid-19 patients, she readily agreed. She had always wanted to study a medicine course at AIIMS. A cousin sister, who was already a nurse, tried to dissuade her from taking up nursing saying it was too hectic. She still went ahead and managed to get admission in AIIMS. It was not because of sacrifices of the profession or the story of Florence Nightingale. “I had heard of her, but it was only after I became a nurse that I realised what it meant. So many uneducated and poor patients come here. When I started seeing their happiness because of what we do, I really started liking the profession.”

David, who grew up in Kundara in Kerala’s Kollam district, lost her father to lung infection when she was 15, and her mother started a small tailoring shop. Her 22-year-old sister is also training to be a nurse. “I am single and so I don’t have to fear going back to children after work, but nurses who are working with Covid-19 patients and have children, are afraid to go home.”

Tsering Choezom, a 32-year-old Ladakhi nurse, who also assisted in the delivery, says she feels relieved that she lives alone and does not have to fear passing on the infection to anyone at home.

Across the road, at the Safdarjung Hospital, which has dedicated eight floors to Covid-19 patients since March 5th, Anjali Raj, 29, who has been among the team of nurses attending on them on the seventh floor, is worried for her two children, aged five and one. She took up a room, around 2.5 km from the hospital, while her husband takes care of the children at home. She walks to the hospital so she can avoid public transport. After a week in the Covid-19 ward, where she monitored patients wearing the PPE kits every day for over two hours, she is on a 14-day quarantine.

“Initially, I was a bit scared, but we were told that these patients need all the support,” she says. Patients started pouring in from all over the world, some in a very depressed state as they were brought in straight from the airport. She recalls a French patient who complained of watery eyes and pain. His eyes were red. It took over an hour for the ophthalmologist to get hold of a PPE kit, wear it and attend to him. He had conjunctivitis and Raj was worried she might get it. He told her he was an artist in Spain and if he could just get some crayons, he would be happy. Raj took some of her children’s crayons the next day and gave them to him. His tests turned out to be negative.

An American, who was in an isolation ward, insisted that the door or window be kept open. The next day he apologised to her. “I love my job,” says Raj. In quarantine, she teaches her children through WhatsApp, and orders essential items on phone. Like David, she too has no regrets. And, after her quarantine, she will return to nurse patients in the Covid-19 wards, fighting one of the grimmest battles, but also witnessing one of the proudest moments of her profession.

At the AIIMS Trauma Centre, which has been dedicated to Covid-19 cases, Kannan Udayan, the night duty nurse in the Intensive Care Unit (ICU), is finding it difficult to communicate with an Afghan patient. He wants his phone and a slipper to walk to the toilet. “Some patients are scared. There’s a stigma attached to the disease. So part of our job is to make them feel comfortable emotionally, though the patients cannot see our faces.” Spending six hours in the ward wearing the PPE kit, with the air conditioning switched off and only exhaust fans ensuring air circulation, hourly checking vital statistics, monitoring urine output and ensuring more than usual hygiene, he forgets everything else. “We don’t drink water before donning the PPE kit to prevent the bladder from getting filled. Inside the PPE kit, it feels safe but it’s also hot and we sweat from top to bottom, making it difficult to see through the transparent shield. Documentation becomes a difficult task.”

After his first night duty with Covid-19 patients ended at 8.30 am, he took a shower, went back to the nurses’ room and switched on the fan. “It felt like heaven. You learn to value simple things. In the PPE, you are in another world, like you are going into outer space. It’s nice to be back to your normal life,” says Udayan, 34. He has shifted into the house of another nurse working in the ICU, away from his wife (also a nurse at AIIMS) and two-year-old child, as a precaution since he is handling Covid-19 patients.

Having undergone a day-long workshop on Covid-19 organised by the World Health Organization (WHO) in Delhi’s Le Meridien hotel on March 7th, he was mentally prepared to nurse Covid-19 patients. “I feel it is an opportunity and a challenge because we are dealing with an unknown virus. It feels like warfare,” says the nurse from Kerala, who initially wanted to be a doctor, but joined the female-dominated workforce of nurses. His WhatsApp display picture is a cartoon showing a medic saving people from coronavirus, depicted as a witch.

Once out of the isolation ward and PPE kit, the worry that he may infect someone in case he has got infected obsesses him, as he moves between the ward, the nurses’ room and his friend’s home. He spends his quarantine time tuned in to Amazon Prime watching movies like Contagion, Parasite and Trance, and remains connected with friends on WhatsApp and group chats. Before winding up, he adds: “Do mention that I am just a part of a large workforce of nurses here at AIIMS and around the world in this fight…. Thank you for listening. At times, that’s all you need.”

With an N95 mask covering half her face and a long green robe worn over her clothes, only her eyes are visible. She has little time to spare before she again gets into her PPE kit. She keeps standing, a little away from everyone, in the long corridor outside the wards at the MMG District Hospital in Ghaziabad, adjoining Delhi.

Ten Covid-19 patients, whom she has tended to, have to be shifted out to another hospital, specially prepared for them in the district. But she still has other suspected cases, quarantined there, to be taken care of. At 27, a year into her job as a nurse in the hospital, Neetu Singh says she is just doing her job, like in the pre-coronavirus times.

“After hearing stories of the highly infectious coronavirus, you do get scared when you see so many patients getting admitted. But once they were here and I went inside the ward for duty, they were like any other patient. I realised that if we don’t take care of them, then who will?” asks Singh, a Delhi girl who wanted to be a doctor. In the entrance exam, she managed to get through for studying Ayurveda, but preferred to go in for nursing. Her parents have not dissuaded her from taking up duty in Covid-19 patient wards, acknowledging that it was part of her responsibility as a nurse.

The hospital has a total of 28 cases, of whom 10 tested positive for Covid-19, and the rest, mostly asymptomatic, are in quarantine. Head nurse Heena Victor, who has been working at the hospital for two decades, says the preparation for the isolation wards at the hospital had begun in February. “For us, the Covid-19 patients are like any other patient. But we worry when our girls go inside. They are working very hard,” she says, waiting for the police to escort the patients, most of whom are residents of Ghaziabad who attended the Tablighi Jamaat conference at Delhi’s Nizamuddin in mid-March, to the special hospital. In the first week of April, as the Tablighi Jamaat members were being identified, quarantined and tested, the hospital saw a rush of cases. Within days, six staff nurses gave a written complaint to the hospital’s chief medical superintendent Ravindra Singh Rana alleging misbehaviour by five quarantined members who were lodged in isolation wards. Outside, there are policemen stationed round the clock. The five who misbehaved were shifted out of the hospital. The Uttar Pradesh government slapped the stringent National Security Act against them.

In Kerala, where the first Covid-19 case was detected in India, Reshma Mohandas, a 32-year-old nurse who got infected from an elderly couple she was attending to, is in home quarantine after her recovery. In February, when the head nurse had asked who would be willing to join the Covid-19 team, Mohandas was among those who had volunteered. After special classes, she began duty in the Covid-19 ward of the Kottayam Medical College hospital on March 12th. She had moved into the hostel to avoid traveling in public transport, leaving her husband to take care of the home. On the morning when she was to begin her duty, she got to know that her patient was a couple aged 92 and 88. “I felt a bit of tension as I got into my new gear that covered me from top to bottom. After that, the tension eased.”

Recalling her days in the ward, she says the couple, whose beds were placed nearby, kept insisting on going home. She had to often treat them like children, coaxing them to eat and ensuring they got food they liked. “A lot of my duty involved listening to them. The husband was very talkative and if you didn’t hear him, he would get upset. The wife sometimes sang devotional songs. They had a lot of willpower.”

Ten days into her duty in the ward, Mohandas started developing symptoms of the disease. On March 24th, her result showed positive and she went into quarantine. Within a week, however, her tests were negative. The old couple, who may not recognise their nurse if they came face-to-face, recovered and left the hospital. Mohandas, in home quarantine, talks to her husband over the phone. “I did not talk to my mother because I know she would cry.”

Once the quarantine is over, she will return to work. Will it be a Covid-19 ward again? She does not hesitate before saying: “I will go wherever I am put on duty.”

In the lives of the health workers, particularly nurses, coronavirus has posed unprecedented challenges—a heartrending paradox of taking risks and facing ostracisation. “They are the ones who have to be with the patient for 24 hours. They have to go near the patient. They are now being called the frontline warriors,” says Harish Kumar Kajla, the AIIMS nurses’ union president. He recommends that the Government arrange in-house accommodation facilities for nurses, who commute in public transport and go back to families, to minimise chances of the SARS-CoV-2 virus spreading.

The number of health workers, particularly nurses infected with the virus from treating patients, has been alarmingly on the rise the world over, including in India, either because of the scarcity of protective gear or negligence. A shortage of nurses could pose a threat to the war against coronavirus. The WHO has warned that the world needs nearly 5.9 million more nurses. Along with partners, Nursing Now and the International Council of Nurse (ICN), the WHO in a report said that in the world, there are just under 28 million nurses, who make up more than half of all the health workers.

The ICN chief executive Howard Catton has said that nearly 100 health workers have died around the world. According to him, wherever there are too few nurses, medication errors and mortality rates are higher. He has warned that richer countries could rely on the Philippines and India to “supply the world with nurses,” which could lead to significant shortages in India.

Across the world, their role is being equated with soldiers at the frontline. “Like in any war, the morale of the army should be kept high. The Government should give all facilities to save the health worker. They are fighting like soldiers against what is an enemy for the entire humanity,” says Kajla.

And everyone knows this war can be won only if they are safe.

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