Corona Diaries - 2

Since by now you know that I have COVID-19, let me go back to how I was spending my days during the two weeks prior to getting infected. I come to work every morning, park in my favourite spot and put on my gloves and mask from the car. Then I head up to the office where I take off my gloves, wash my hands and head to the ward to make a list of patients and see if anyone is sick.

This is what I’ve been doing every single day, ever since I started working in Amiri in November 2011. Nothing really changed apart from becoming a senior, and that’s just a title. Your responsibilities grow with you. When I was an assistant registrar, I would only be responsible for my own patients, now as a senior, I’m responsible for all our patients as well as the safety and wellbeing of my junior doctors as well. Oncalls are even more scary, don’t get me started on oncalls. Being the most senior medical doctor available in-house is a very tough position to be in, a thought that keeps me up during night calls.

Work always starts before 7 am for me. So, I enter the ward wearing my mask and a fresh pair of gloves, make my list and ask about my patients. Sometimes I go assess any sick ones, other times I let the juniors do their work and then start rounds when they’re done. Usually, the team rounds at around 9 and after rounds straight away we close and one senior/registrar and one assistant/trainee stay until 1 to finish off any outstanding issues. This is what we’ve been doing ever since MOH (Ministry of Health) said that we are not operating as usual, and it’s a system that has been working perfectly for us. During rounds, patient contact was limited to the junior that examined and the one rounding. No unnecessary staff enter to see patients and we were always wearing our PPE (personal protective equipment); what was available to us anyways.

It started becoming a habit to watch the daily MOH press conference. We try to finish rounds early so that I can hear the number of cases daily live on TV in the office. Sometimes if we were still rounding, we would glimpse the numbers on the TV sets in patient rooms. Everyday, I would wonder when this nightmare would end? When would life become normal again? When would it all become a memory?

So after work, I would head home. I couldn’t go to the gym or join bootcamp classes. Something I had come to love over the past while. I would head home and sit in my room mostly. If I ever sat with my family, it would be on my own couch and that was more than 2 metres away from my father and brother. I had not hugged or kissed my dad in nearly a month. As soon as I get home, I would take off my scrubs and shower before I would go down to our main living room. All my clothes would be washed separately. Let me just say this, I had stopped wearing scrubs the moment I had finished medical board. Scrubs were only back for “The Corona Era”.

Writing this in retrospect, it all fits in, but when you’re actually living it, day to day, it’s difficult to put together. My first encounter with the infected patient was on Friday, April 3rd. She was an elderly lady with multiple comorbidities. She was admitted as a case of chest infection and had been cleared from the COVID-19 team because she’d had two negative swabs, they had suspected aspiration pneumonia rather than anything else. So, I saw her first with my junior on Friday morning. We were post night shift and wanted to finish rounds so we could head home early to sleep. It had been a long night. We wore our masks and gloves and went into examine her. The total encounter would have been around 15 minutes as it was the first time we meet the lady. We usually see the file, all lab results and radiology imaging prior to entering the room. She was comfortable at rest and only required a litre of oxygen to maintain her oxygen saturation. What that means for non-medical readers, the amount of oxygen in her cells was adequate; normal oxygen saturation in a healthy individual shouldn’t drop below 99-100%. Elderly have poor lung reserve and usually we accept anything above 94% to be normal. Our lady was stable, I added an antiviral to her antibiotics and said to follow up her chest x-ray for Sunday.

My rounds were Sunday, Tuesday and Thursday, however I see sick patients even if it’s not my round. She was stable however her chest x-ray seemed to worsen. We thought that there might be an element of heart failure, therefore an echocardiogram was requested and she was given diuretics; she seemed to improve a little bit and her chest x-ray was to be repeated on Wednesday. Now we have a confidential group for following up our patients and their details. On Wednesday, I was doing some administrative work in the office when I saw her new chest x-ray. It looked significantly worse. I immediately told my team to send a COVID team consultation and I spoke to the head directly telling her my concern. I explained that the patient had two negative swabs however her last X-ray was significantly worse and I felt she needed to be shifted to the COVID ward to be swabbed again. She was immediately shifted within a few minutes of the phone call. This was Wednesday afternoon. She required to be kept on 15L oxygen that night and was assessed by the intensive care team. She improved initially with diuretics but then worsened again and the ICU team was monitoring her regularly. Thursday night we were told she was COVID-19 positive. The ICU team intubated her and she was shifted to Jaber ICU that night.

Given my obsessive personality, you can understand how I was continuously asking about her swab result. I would literally ask every hour on the hour. During this time, I maintained an even greater distance from my colleagues and family at home. I remember where I was exactly when I saw the result. I was watching Friends on Netflix with my brother sleeping on the other couch, at least 3 metres away from me. I remember Joey wiping raspberry jam off his face when I looked down at my phone and noticed the result. It was 11:30 pm. I immediately covered my face with my shirt, switched off the TV and went up to my room and isolated myself. It was Thursday night and raining heavily outside. If the weather was stable, I would’ve gone to get swabbed there and then. However, I thought it be wiser to wait until morning. I immediately made a mental list of which doctors saw the patient and examined her. I didn’t want to scare them all at midnight so decided to wait until morning to call them all for swabs.

That was the longest night of my life. Literally. I was unable to sleep and my brain kept thinking of all the possible scenarios. What if I’m positive? What if I’m negative but need home quarantine? What about my family? What about my friends? What about then rest of the patients? What about the nursing staff? What would happen to my team if we all were put in home quarantine? My brain was in overload until I finally fell asleep at around 5 am for an hour or so.

At 8 am, I thought that was an appropriate hour to start calling my colleagues. This was our first “golden weekend” for more than a month. Golden weekends are when the team is not oncall on either of the weekend days, which means we don’t have to come to the hospital. We usually assign one team member to do rounds on Saturday and it wasn’t my turn because I rounded during the last one. I informed the 4 team members that we would meet at 9 am to get tested. I informed them to wear masks and stay isolated from their families until all this was over.

I put on my N95 mask and gloves and headed out. Before leaving, I passed by my father’s door and told him where I was going from behind the door. He was shocked and yelled in disbelief, but I had no time for drama. I told him I’ll speak to him when I got home. I understood his worry completely, but I needed to get the swab done as early as possible.

I drove to Amiri, my second home away from home, on Friday April 10th. We gathered around with the rest of the team before entering the test center. Everyone was scared in their own way. One cried. Another showed no emotion. The third made jokes. Everyone had their own coping mechanism. I acted like the leader that I am. I made sure they were all well and had a place to stay isolated at home. We went in to get the swab done.

How can I describe the swab you say? It feels like a small bug went up my nose and started poking around my brain. They have to keep the swab in for at least 7 seconds, I couldn’t tolerate it and tried to push the doctor’s hand away. It was more uncomfortable than painful. It’s as thin as a toothpick but long and very irritating. I sneezed immediately after and my eyes watered like crazy, they all thought I was crying. We had a chest x-ray afterwards which was completely normal.

Now the hard part was about to begin.

The wait…