Corona Diaries - 18

28 days later, I went back to work.

Why does it feel like I was away for a lifetime? It doesn’t feel like a month. The drive to work was very peaceful. There were still many cars on the road, even though we were in complete lockdown. It was good to see the sea again. I always take the road that allows me more seaside views until I get to Amiri. The sea calms me. I always get a view of Kuwait Towers on the way to work too and that’s always pleasant. I went up straight to my office, wearing my N95 and my gloves. My calendar still read Thursday April 9th. That’s the last day I worked normally. I wondered when life would be normal again. When would we have morning rounds and medical students again? When could we go for our morning coffee with our colleagues again? When would be able to gather and sit and chat and eat together? When could we have normal human contact again? When would the “Corona Era” finally end?

I was greeted with smiles hidden behind masks. Everyone was happy and cheerful to see me again and I felt blessed. I went on Sunday to get my papers done however my first oncall would be on Monday. All the people I saw were happy to see me and most had no fear of getting close. We were all wearing masks and gloves and there was no way I could infect them, even if I was still shedding the virus. I was maintaining a safe distance from everyone, even my closest friends. I wanted to hug them so much but that would have to wait. However, there were a few people that didn’t want to get close and by “close” I mean at least a metre away. I didn’t take it personally because some people are more scared than others, some are also very obsessive and extra cautious. I wondered what patients with obsessive compulsive disorders (OCD) were going through at the moment. It must be extremely difficult for them to adjust and cope during this period.

I knew I wouldn’t be able to continue writing daily or every other day once I got back to work. It’s impossible. Work takes up at least half of the day. Even if the single shift is only 8 hours, you still have to follow up patient results by phone calls and the Whatsapp groups are nonstop with updated protocols and announcements. Our oncalls are every third day now however we have isolated COVID wards and the patients need to be rounded on daily. I was oncall on Monday, then had to round Tuesday, Wednesday, Thursday and that’s when we were oncall again. There are six wards dedicated to COVID patients only and each can hold up to 16 patients currently, keeping in mind that we need to keep general beds isolated so bed occupancy is reduced by half; general rooms that could occupy 4 beds previously can now only occupy 2. The stable positive patients can be shifted to one of the multiple quarantine areas scattered around Kuwait, such as Al-Khiran, Al-Zour, Jlaia, Mishref quarantine Area and Al-Retqa. Any patients requiring oxygen must go to Jaber Hospital or Mishref Hospital, however most of the time there are no beds available and they stay with us until they become stable to be shifted to quarantine instead. Any unstable patients that cannot be managed in the wards are shifted to our COVID Amiri ICU. We are nearly reaching our limits at the moment. The ICU is full and we have to manage unstable patients in the ward. Patients that are desaturating on maximum 15L of oxygen may have no ICU beds. We are “awake proning” them and attempting to manage them in the ward.

The daily admission rate may reach above 20 and the transfer or clearance rate may be less due to bed shortages all over Kuwait. We also have an area where asymptomatic, stable patients can stay until transfer is arranged. This can hold up to 30 patients at any one time. We have dedicated teams that are in contact with dispatch centres to arrange transfer of patients and they are working continuously, 24 hours a day; the moderators. There’s another dedicated team for swabbing patients; the swabbers. We as medical COVID work closely with the Emergency COVID team too and there are COVID members from all specialties such as surgery, cardiology, urology and nephrology. Everyone is working together in harmony, something that’s making the work feel less heavy.

Let me talk about how we protect ourselves. We wear an N95 mask that doesn’t allow us to breathe normally and makes our voices sound funny. I keep raising my voice because I don’t think anyone can hear me and end up with a sore throat at the end of my shift because I’ve been screaming the entire time. Then we put on our goggles and that’s when you know whether your mask seal is correct. If your goggles fog up then you need to seal your mask properly. Then we put on our hazmat white suit that cover us from head to toe. Then we put on our gloves, shoe covers and face shields. Then we have to walk around for at least 8 hours in this attire. We don’t recognise each other unless someone has a distinctive voice like me. We all look the same in our white suits. We can’t hear each other because of the many layers. We can’t even lip read because we can’t see anyone’s lips. So, we don’t understand each other, we can’t hear what our patients say and they can’t hear us; they can’t see us either. We cannot hold our phones without protection or a plastic bag so even communication becomes really difficult.

Walking or doing anything that requires respiratory effort is exhausting. You cannot breathe normally so you cannot function normally. Even going up one flight of stairs. becomes difficult because you’ve pinched your nose so hard and can’t take a full breath. Walking 100 metres becomes exhausting and you start to sweat. Then your goggles or shield fog up and you can’t see anything. It’s a struggle, I have to admit.

Then when it comes to the end of your shift, you have to take everything off again, making sure that you don’t make a wrong step. You have to alcohol wash in between every single step and you have to disinfect anything you touched and your phone has to be cleaned with alcohol thoroughly. I keep my hazmat suits in a separate bag so that I can reuse them later in case we run out of suits. The most painful part is taking off the mask. You don’t realise how painful it was until you take it off. I pinch my nose so hard when I put it on so I get an inverted V red mark on the bridge of my nose when I take it off. Two symmetrical red lines appear on my cheeks on either side from the mask pressure and seal. I don’t get a chance to have a proper look at my face without the mask before throwing it out and putting on another mask to head back to my office.

It’s tough. It’s not an easy job. It takes guts and it’s not for everyone. Some may be fearful of the unexpected. Some may not be able to cope with the demand and struggle. We don’t know what tomorrow will bring. We have had 900-1000 new corona cases every day for the past 5 days in Kuwait, I wonder how long that will last. How long until we won’t be able to cope with the number anymore? How long will we have until medical staff start collapsing? How long until nursing staff start collapsing? How long do we have until we won’t be able to accept any more patients? When will we finally reach the peak so we can start becoming hopeful again?

Kuwait has many corona infected healthcare workers in the past 2 months and the numbers are increasing. The last number released was 105 and that was nearly a month ago now. That number has definitely increased; I’m suspecting it’s above 500 now. We have lost the lives of six healthcare workers to corona in the past 2 weeks. How many more will we lose? Many are sick in the ICU, in hospital wards and some are stable and recovering at home. I sincerely hope we get through this soon before we lose any more of my colleagues.