Looking back at the coronavirus war room

In July last year, while Delhi slowly emerged from the unprecedented trials of a lockdown and grappled with an average of 2,000 Covid-19 cases a day and a death toll nearing the 4,000-mark, HT spoke at length, over multiple phone calls, to two young doctors on the front lines of the fight against the disease about their experiences.

Dr Richa Narang and Dr Saurav Kumar should have been done with their postgraduation -- Narang in anesthesiology and Kumar in general surgery — and in a job of their choice by April 2020; instead, with exams repeatedly being postponed, the lockdown and the pandemic spreading rapidly in the city, they found their teaching facility — the Lok Nayak Jai Prakash Narayan (LNJP) hospital being turned into the city’s first dedicated centre for Covid-19. All other work was now indefinitely on the back burner; as “junior residents” (which is what doctors in the final year of postgraduation are called) they were now the core ground force in the battle, working 14-day shifts interspersed with 14 days of quarantine.

The two doctors witnessed it all: the transformation of the hospital into the largest Covid facility in Delhi, the initial days of “complete chaos and fear” when there weren’t enough “ventilators, oxygen masks or even cannulas”, learning to work in PPE suits in which they felt “suffocated” and would often be “terribly thirsty, desperate to go the washroom, drenched in sweat and finding it difficult to see through the fogged goggles — all at the same time”; and learning to deal with death.

Narang, who grew up in a small apartment in Karnal in Haryana, said that she always wanted to be a doctor because she grew up idolising her sister, 12 years older to her, who is a doctor too. Narang is the youngest of four siblings born to a former school teacher and her husband, a lawyer.

“I have a drive, I want to save lives, I want to keep trying,” Narang said in July, her voice choked with tears after a patient she cared for two weeks died in front of her. “I was very affected by the way patients died on my first shift: unable to breathe, no family members around, having spent all the time in hospital in isolation without loved ones.”

Kumar grew up in a large joint family on a farm on the outskirts of Araria in Bihar; his father taught Botany in the government college in the city and Kumar is the older of two brothers, both doctors.

“When I got into MBBS, I was not just becoming a doctor; for me, it was a generational leap,” Kumar said last year.

“In 26 years, I’ve seen two completely different lives, one in the village where I grew up, and one here in the city. And now I am experiencing being on the front line in a pandemic.”

How did life unfold for the two doctors since those conversations in July, as the pandemic hit a terrifying peak in the city in October and then slowly began to ebb?

Richa Narang: Finally in August we finished all our MS exams. August 1, I gave my last practical exam, got my degree. It was a Saturday. On Monday, I went back to LNJP and joined the hospital as a Senior Resident. I had not met my parents since February, yet they insisted that I join immediately so I could be of service at this time of emergency. That was very inspiring. The one day’s break, on Sunday, I spent with my family. I was meeting them after six months but I spent the entire time in a mask and a face shield, keeping my distance. I ate my meals alone in my room.

Saurav Kumar: Immediately after completing my MS, I left LNJP and started preparing for entrance exams for post-MS superspecialty courses. I cleared those exams too. In November, I joined RML (Ram Manohar Lohia) hospital. I joined because it was not a fully Covid hospital. Being a surgeon, Covid had a very negative impact on my training. For months at LNJP I did only Covid management, nothing to do with surgery at all. In November, when I put on my scrubs and entered the RML OT (operation theatre), it was the first time in about eight months that I was doing surgery. I cannot describe the feeling of happiness, it was almost an intoxication. I had to do a stomach closure on a 22-year-old. It felt to me like a second life!

Narang: I was on the ground through the worst wave in Delhi. I felt very strong and proud of myself. I was constantly in the ICU, fighting to save patients. Yes, it was hard, it was sad to lose patients, but I kept going, wearing that PPE kit again for six hours a day in the ICU. A patient came in, 18 years old, so strong and positive, fighting Covid, but then she died of kidney failure. There was a 76-year-old patient who was suffering badly, but when I went to help, he held my hand and thanked me and blessed me and said that I’ll do a lot of good in my life. We were both crying. Thankfully, he survived. Another lady, around the same age, did not. Just before I intubated her, she said, even though she was struggling to speak, “god will bless you and look after you”. Then I put the tube in and later that day she passed away.

Kumar: RML was the only Delhi government hospital at that time (November) where surgeries were being done. All emergencies were being sent here. We were running full, and of course when a patient came in to casualty we had to admit without knowing their Covid status. In an emergency, you can’t first do a Covid test and wait for the result, and then admit a patient -- you have to straight away start procedures. Outside of emergency, all patients coming in were being screened by the SARI (Severe Acute Respiratory Infections) team to be sent to Covid or general wards. I didn’t have to wear a PPE kit anymore, just double masks, but after being in a Covid hospital like LNJP, once I emerged from that, all fear of the disease had disappeared.

Narang: The situation in October was what I imagine a battlefield will be like. We would lose a patient in the ICU, and immediately that bed will be filled with another patient coming in. One day when I was on duty there were five deaths. At one point we were losing 8-10 patients every day at the ICUs. A patient dies, is taken out, another patient is rushed in. It was relentless.

For me the drill was the same. Fourteen days of work, 14 days of quarantine. On the seventh or eighth day of my quarantine, I would get a Covid test done, and if I was negative, I would go home for 2-3 days. I never tested positive. But then, in October, my father tested positive. He is 78, a heart patient. My mother is 80 and mostly bedridden. That was the worst time for me. I shifted my father out to an apartment we have in Noida; left my mother under the care of her domestic help. I took care of my father and worked my shift at the hospital. More than the physical stress, and the long drives, it was the emotional stress that was really hard. I slept badly at night thinking what if my father’s oxygen saturation drops at night and he is not able to call for help and I don’t wake up? Luckily, he got through it.

Kumar: Once I was done at LNJP, I moved out of the hostel and into an apartment complex near Ferozeshah Kotla because it’s close to the MAMC (Maulana Azad Medical College) library, where I was studying. I was living alone, but that complex has a lot of young doctors like me, so I had a group of friends around which was important. Otherwise it can get so depressing and lonely. I could not risk going home to Bihar. Life was highly restricted. Just my apartment, the library, and back. This was how it was from August till November. No weddings, parties, birthdays, holidays... I still haven’t met my family. But they are all doing well. My brother has just finished his internship at the Armed Forces Military Hospital in Jammu.

Narang: When the fall (in cases) started, it was a massive relief. From every ICU being full all the time, people dying and instantly getting replaced by another patient struggling for life, a time came when there were no mortalities. A time came when there were two patients in the ICU, and no calls for more patients coming in. That’s how the new year began for us.

I think the one great thing that happened through this is that our infrastructure improved a lot. Every bed in every ward in LNJP now has oxygen supply. Earlier most wards would have 2-3 oxygen beds, and some had none. We got a lot of ventilators. In the anesthesia department, we had only one ICU to begin with. By October, we had four ICUs, each equipped with ventilators. We got lots of Bi-PaP masks (a small, pressurised breathing device) which worked wonders for Covid patients.

Kumar: Covid has taught us some important things. We spent an extremely hard year learning these lessons, we should not let go of them easily. Hand hygiene for example, or standing in line, and maintaining distance. From personal experience in government hospitals I can tell you that there used to be constant chaos at the OPDs (out-patient departments) --people pushing and shoving -- now we see them standing in neat lines. They don’t have six feet distance between each other, but there is some distance. See, TB is also contagious, and it’s highly prevalent in India. We used to constantly tell people to not cough in our faces or in each other’s faces but they did not listen. Now they are covering their faces. I think because of Covid, the spread of some of these other infectious diseases are going down.

Narang: In the first week of February, I got a Covishield jab. Then I celebrated my birthday in the Covid ward on night shift. In January, LNJP finally started admitting non-Covid patients too, people with serious illnesses like cancer who have been waiting for months for their surgeries. This week I’m on duty at the non-Covid OT.