A day battle inside a Covid hospital: a doctor's perspective

By Quan The Dan   September 4, 2021 | 10:01 am GMT+7
It is 7 o'clock in the morning, and the daily briefing starts in a tense atmosphere. The department head grimaces: "How did we lose this case, weren't there positive developments yesterday?"
Quan The Dan

Quan The Dan

"The patient's respiratory failure worsened in the afternoon, we tried to pull it back but couldn't, and at night they had a cardiac arrest," the staff on duty, palpably tired, says.

No one says another word. Such a cruel disease. Suddenly a walkie-talkie crackles with a call from the wards: "Emergency, patient in bed number seven has a cardiac arrest." Everyone instantly turns to look at the monitor. Health workers can be seen diligently performing chest compressions. Several staff members at the briefing quickly stand up and pull on their protective equipment in order to go and provide support.

The administrative room, which serves as the department headquarters, is noisy like a market. There are sounds of people calling each other, arguing, asking each other things in all three regional accents, north, central and south. Health workers from all over the country are present.

The briefing resumes with a listing of serious and critical patients and then quickly concludes, and everyone stands up and leaves hurriedly.

People disperse to various corners where we carefully put on our personal protective equipment (PPE). This must not be rushed and must be done carefully since we would be exposed to an extremely dangerous and infectious environment.

The PPE set includes a number of items, which must be put on and then disinfected step by step until we finally become fully covered in white from head to toe.

After putting on the PPE, we slowly entered the danger zone, where the patients were waiting.

The ward with the most seriously ill patients is the red zone, which is completely isolated since it is the most dangerous.

Next is the transition area called the yellow zone, and finally the medical staff's safe base, the briefing room, dubbed the green zone.

Movements between the green and red zones are carefully regulated. When going from green to red we must wear the PPE, and when leaving the red zone we must remove the PPE and carefully disinfect from head to toe before entering the green zone. That is in theory, but the risk of infection is still ever-present.

We finally entered the ward. With the PPE on, every movement became very difficult, the goggles became foggy, and even breathing was difficult. We spread out to visit, check on the patients and encourage them to persevere.

Every one of the patients was suffering from shortness of breath, coupled with anxiety and panic from witnessing other patients in the room get worse and occasionally pass away.

It is because of this anxiety and panic that breathing becomes faster, causing them to receive even less oxygen.

Many patients listen to the doctors and practice breathing evenly while lying on their stomach, and their condition gradually improves. On the other hand, those that complain frequently often get worse. Speaking too much is strongly discouraged, for it increases the risk of infection. We had to practice speaking and breathing gently, not taking deep breaths or suddenly exerting ourselves to avoid creating strong air flows through our masks, which makes it easy to spread the infection.

That said, when a patient's condition suddenly worsens we forget it all, our professional instincts take over, and we rush to help with the emergency so fast that the protective equipment might fall off.

Those with loose protective equipment are immediately ordered to leave, disinfect themselves and put on another protective suit.

The dangerous environment and tight protective equipment make it very difficult for us to work. Nurses struggle to perform venipuncture. Normally very dexterous at drawing blood, here they sometimes need two or three attempts since having to wear multiple pairs of gloves hinders their ability to feel with their fingers.

It is also difficult for doctors to examine the patients since they cannot use stethoscopes and must be very brief when asking patients questions.

At times like these, observation skills are of utmost importance. By observing whether patients breathe gently, with difficulty or abnormally, and noting their facial expressions, sweat, skin color, we can assess the progress of the disease.

And then by measuring the oxygen levels in their blood and observing their oxygen consumption, we can gradually draw up plans for what medicines to use that day.

The majority of severe patients are obese. Regardless of age, obesity means the disease is likely to worsen. Seeing those patients breathe with difficulty, their heavy layers of belly fat going up and down, traumatized me to the point that I significantly cut down on the amount of food I ate to avoid obesity.

Nurses and doctors alike go to empty patients’ bedpans. They cannot leave their beds since a lack of oxygen would cause them to stumble and fall immediately. We also fetch water for them to drink. The patients have difficulty breathing and breathe rapidly and so become severely dehydrated and need to drink several liters of water a day.

Severe patients who can drink on their own have an easier time though it is still very difficult. As for critical ones with oxygen masks covering their entire face, sometimes they suffer from severe dehydration, with their whole body drying up.

There is a serious shortage of health workers, and we do not have enough to have one stay by the side of and assist every patient. I have often thought it would be great to have a band of volunteers consisting of recovered patients who have been trained to assist with simple tasks.

As the day went by, severe patients were treated and less severe patients were recovering, and so we finally felt reassured despite being drenched in sweat.

Just as it was time for us to return to the green zone to write up medical records, there was a commotion from the room next door. A patient's condition was worsening. All the medical staff in the room gently pulled the machines toward the patient's area and then rushed in for emergency treatment.

After a few minutes the patient's heartbeat returned, and the ventilator was reattached for the patient to resume breathing. My colleagues were covered in sweat as if they had just showered.

Medicl staff take care of patients at the Becamex Binh Duong Covid-19 field hospital. Photo by VnExpress

Medicl staff take care of patients at the Becamex Binh Duong Covid-19 field hospital. Photo by VnExpress

In my career of nearly 40 years, I have never seen such a dangerous lung disease. When first infected, the patient just has a few dry coughs and is still healthy, but just a couple of days later they have difficulty breathing and have to be hospitalized.

The breathing difficulty suddenly worsens rapidly. When first admitted a patient just needs to breathe oxygen through a nasal cannula at a flow rate of five liters per minute, but then is quickly switched to oxygen masks at a flow rate of 15 liters per minute, but their condition still does not improve.

The oxygen saturation level (SpO2) is below 90 and so we have to switch to using high-flow oxygen at 60 liters per minute. The oxygen flow through the tube is strong enough to make an audible hissing sound, but the patient's condition still does not improve.

For cases like this, doctors are forced to turn to their last resort: intubation and mechanical ventilation. However, it appears the ventilator is a one-way ticket with few surviving to tell the tale. This is not just in Vietnam but also in the U.S., Italy and other countries.

In fact, doctors in western countries, before intubating patients, let them make phone calls to their families, almost like giving them the chance to say their final goodbyes.

To this day, despite having helped treat many patients, Covid remains a puzzle to me. People might sequence the virus genome, know how it attaches to which receptors to enter the body and how it replicates inside human cells, all of which means we seem to know everything about the virus already. Yet why are patients still dying?

In medicine, if we still let people die of a disease it means we do not know everything about it.

By noon we finally entered the transitional yellow zone, carefully removed the virus-covered PPE, quickly went to shower, disinfected ourselves, changed into new clothes, and returned to the green zone to write up medical records, distribute medicines or monitor the cameras.

The next group then staggered into the red zone. And thus continues our battle.

*Quan The Dan is a doctor now working at the Becamex Binh Duong Covid-19 field hospital. The opinions expressed are his own.

 
 
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