For most doctors, the COVID-19 pandemic has been a humbling experience. It has not only snubbed the hubris they had in the progress of modern medicine and made them realize their limitations and fallibility, but also caused irreparable damage to their self-worth, health, and sanity.
A year and a half of dealing with this crisis has led to extreme burnout, depression, and anxiety, but the most lingering feelings that doctors struggle to cope with, are profound loss and grief.
A Conveyer Belt of Dead Bodies
Dr Hemant Thacker, an Internal Medicine Specialist at Jaslok Hospital And Research Centre, Mumbai, told News18.com, “We have not seen so many deaths ever before. This has certainly shaken us. It felt like a conveyor belt where living and breathing people turned into dead bodies: patients came, they got worse, they were put on the ventilator and; then so many of them died and were taken to the mortuary. This cycle continued for days, despite our best efforts."
Dr Thacker said that the limitations of modern medicine confounded them. “We tried everything in the book, from immune interrupters to antibiotics to different modalities to all sorts of mechanisms, including steroids, but nothing helped in so many cases, and the patients succumbed. We helplessly saw them come in with 2 litres, 6 litres or 12 litres non-invasive ventilators and watched them die, irrespective of how hard we tried. Hope was a hard thing to find in those moments," added Dr Thacker.
The feeling of helplessness only aggravated during the second wave. Dr Vijay Kumar Sinha, the Associate Director of Nephrology and Kidney Transplant at Jaypee Hospital, Noida, said he saw many of his dialysis patients suffer and die because they couldn’t get themselves the basic dialysis facilities.
“During the lockdown, many kidney patients who require dialysis support could not reach dialysis units and suffered heavily. Those who got infected were disallowed from getting dialysis in their existing units, and they were referred to COVID hospitals. Unfortunately, most of the COVID hospitals did not have dialysis facilities."
“Patients had nowhere to go. As a result, many of them died due to the lack of proper medical care," he added.
As Soldiers Wear Uniforms, We Wore Our PPEs
Dr Sinha pointed out that doctors and other hospital staff push through, as soldiers do on battlefields despite the dire situation. “The fear in the covid units was only allayed by the smiles and chirping of our young nursing staff and doctors," said Dr Sinha.
“As Senior doctors, we would be in the COVID units for few hours on some days of the week, but they were there for weeks and months. Many of their colleagues had been hit by the virus, some suffered from the severe disease themselves, but no one refused to do their duties. They wore their PPEs just as soldiers wear their bulletproofs before entering the war zone. There was the same spirit of saving the fellow human beings and countrymen," he added.
On many occasions, we were astounded by the bravery of our patients too.
“One of my very sick patients who required ICU care refused to take it. She would put up a brave face every day during the rounds. Despite being on maximal oxygen support, she would behave as if nothing has happened. Ultimately after about three weeks, she recovered and managed to go home. I think her brave act had saved many lives as her ICU bed went to the next critical patient. Later she confessed that she feared if she went to ICU, she would never return," recollected the doctor.
Abuse, Assault, and Fear
While both medical staff and patients tried to put on brave faces, in several cases, patient deaths led to altercations, and doctors faced the brunt of it.
Dr Davinder Kundra, Consultant – Pulmonology at HCMCT Manipal Hospitals, Dwarka, New Delhi, told News18.com, “I had to bear the wrath of patients’ families when I could not meet their demands for hospital beds or oxygen support arrangements."
Dr Kundra explained that although he empathized with the families, he could do little to help them and the fear of an amplified retaliation from patients’ families consistently traumatized him. “During the peak of the second Covid wave, it was difficult to answer every query of patients as we
were stretched thin dealing with an increased number of COVID patients, but that didn’t go down well with many families, who kept calling to enquire about their loved ones. Their anxiety was palpable, and I was at the receiving end of their anger too, which only made me ponder on my own limitations as a human being, and a doctor, and the horrible situation we have all found ourselves in," he added.
Working On Exhaust Fumes
As days turned into months, and months added up to one and a half years, most doctors felt they were running on exhaust fumes, with burnout and extreme fatigue setting in their overworked bodies.
Dr Kundra pointed out, “We doctors had no time to look after our own health, which led to many subclinical or clinically evident problems. From anxiety to gastric issues, to body aches with radiating backache and nutritional deficiencies due to lack of proper meals and inadequate sleep, all these impacted our health physically."
Dr Tushar Tayal, Department of Internal Medicine, CK Birla Hospital, Gurgaon, told News18.com that the long working hours wrung doctors out of all their energy.
“Most of my colleagues and I were working 18-20 hours per day and answering hundreds of phone calls daily whilst managing sick COVID patients wearing PPEs. It obviously took a toll on our bodies," said Dr Tayal.
“Erratic food timings, long working hours, lack of leisure time and lack of exercise has caused me to gain weight and become more lethargic, but we cannot rest; for now, we have miles to go," he added.
Many doctors also found themselves struggling with the virus as they treated their patients. Dr Sneha Chandwani, a Senior Resident at the Department of Pathology, Tata Memorial Hospital, Mumbai, said that during the second wave, as she coped with an increasing number of cases, she became COVID positive.
“During that period, four of my family members (including my grandfather) tested positive along with me. It was a challenging phase for me, and while I came out of it, two of my relatives didn’t. What made things worse was that despite being a doctor, since I was under quarantine in my place in Mumbai, I couldn’t be there with my family. It was a difficult time for my parents and the extended family as we were all grieving but couldn’t visit or comfort one another," she recalled.
The Silent Mental Health Epidemic
Since we are still not out of the COVID crisis, doctors are at the forefront of this war, enduring mental wounds every day, and still continuing their duty.
Dr Ambrish Dharmadhikari, Psychiatrist and Head, Psychiatrist & Head, Mpower – The Foundation & Program Coordinator: The Mpower Hub, told News18.com that counselling doctors have made him acutely aware of the magnitude in the past year of mental health impact this pandemic has had on them.
“I’m counselling a doctor who still feels anxious treating ICU patients. He reported he suffered from the constant fear of losing patients and getting beaten up by their relatives," explained Dr Dharmadhikari.
Another doctor consulted Dr Dharmadhikari for sleep disturbance and depression symptoms. “He is struggling financially. He had taken loans to expand his hospital, but his practice suffered a lot due to the lockdown.’ Who would have ever thought that doctors won’t have money to eat?’ he asked me recently. Depression further affected his confidence to operate. He became afraid that if he doesn’t do it right, he might earn a bad name," recalled the doctor.
Broken Relationships and Isolation
Several doctors developed relationship issues due to excess work and the constant threat of family contracting infection. In some cases, families also blamed them for increasing their risks of getting infected, which triggers guilt and lead to several mental health issues like irritability, stress, substance abuse, anxiety, and depression.
With no self-care and time devoted entirely to work, doctors with pre-existing medical conditions faced worse symptoms.
Dr Preeti Parakh, Psychiatrist and Head, Mpower the Centre, Kolkata, told News18.com, “I have seen quite a few patients who are doctors, and the most common complaint from them is about anxiety, insomnia, feelings of helplessness and intense loneliness when they stay away from their families to avoid infecting them."
Dr Parakh pointed out that especially those with young kids report feeling very inadequate when the child complains about their absence.
“A young doctor I know fears that by the time the pandemic ends, his one-and-a-half-year-old daughter would have probably forgotten him," recalled the doctor.
“A case that I have been dealing with is of a doctor whose partner felt neglected at home and ended up having an extramarital affair. They have recently filed for divorce. Another doctor shared his anguish over being slapped by a COVID patient’s son after the patient died. What appalled him was that the patient’s son, who blamed him for his father’s death, did not have any guilt at all for infecting his father after contracting COVID at a party with friends," recalled the doctor.
“He even said that he regretted choosing this profession," she added. Many frontline workers report smoking more than they used to before the pandemic. Some are also opening up about abusing anti-anxiety medicines and other drugs. And, of course, mental health experts have also not been immune to mental health issues during this pandemic.
Dr Parakh told News18.com, “Both my husband and I are mental health professionals, and we had gotten into the habit of sharing case studies or talking about colleagues who had succumbed to the illness, till we realized that our evenings together had become quite morbid."
“We now have made a pact to avoid discussing pandemic related losses, and we even limit our exposure to pandemic related news. Thanks to our mental health background, we were able to modify our behaviour before it had any significant impact on our mental health," she confided.