First it was ignorance, than it was hasty decisions and finally it was a lucrative business model for private hospitals, yes that is how the pandemic went for us. We share this book excerpt from one of the chapters of ‘Mad’demic In A Pandemic‘ by Dr. Manigreeva Krishnatrya narrating his experience as a doctor during the time of pandemic
Chapter: Follow the Science !
We are amidst a lockdown, yet again, after one year into the pandemic. However, this time around, our policy makers have realized the economy is vital. So, essentially everything is open but yet, more or less everything is closed. This can only be realized by people who have witnessed this absurdity. For the future generations reading this, I am sorry, I can’t or rather it is impossible to make anybody understand the situation by describing it in words.
In the “second wave”, because of the increasing virulence of the god damn virus, the test positivity rate was higher than the first wave. It means more people are likely to be infected this time around. In other words, it is likely to rip through the entire population, regardless of measures like night curfew or travel restrictions like inter-district travel ban by road.
Coming to night curfew first, whosoever the bureaucrat in the concerned ministry of the government, or “babus” we call them, thought about this public health response must be first put in a mental asylum in greater public interest. A night curfew implies that the god damn virus is kind of nocturnal bird like an owl.
Next is the inter-district travel restriction. This buffoonery is even better than the night curfew. Here, you cannot travel from one district or state to another by road, but you are allowed to travel thousands of kilometers by train from one place to another, or even different countries by air. This was like making a mockery of the god gifted human cognitive function, which is “common sense”. This is exactly when I said on record, “common sense is now a rare sense”.
Meanwhile back in our hospital, as expected, we have to re-start the dedicated Covid Ward after its brief closure after the first wave. However, the ward does not have a ventilator unit or intensive care unit for patients with cancer and incidental SARS-CoV-2 test positivity or mild COVID-19. Patients with cancer and incidental SARS-CoV-2 test positivity are persons who are healthy sick for the god damn virus but seriously unwell for cancer to begin with.
Nonetheless, as days go by in the second wave, the need for more beds in the Covid Ward also kept on increasing, as the virus was running amok in the population. It meant more patients with cancer and healthy sick for the god damn virus. In my humble opinion, this should be true for other diseases as well like serious kidney ailments, heart diseases, lung diseases etc.
It also means, the need for lateral integration of health care was needed from the beginning instead of segregation of health care based on only one disease, which is COVID-19. Now, seriously ill people due to any disease requiring intensive care unit (ICU) treatment incidentally detected with the god damn virus or mild COVID-19 will require exclusive COVID-19 ICUs. No health care system anywhere can create extensive COVID-19 ICUs to meet the raging demand during a pandemic, when the virus is ripping through the population, regardless of any nonsensical measures like lockdown, night curfew, odd-even formula for cars on road, right side and left side opening of shops, etc. And, no matter how much virtue signaling the balcony class of people will do, shall work to prevent people from catching the god damn virus. This is the cardinal truth! An awful story to tell here!
In our hospital, one patient with lung cancer underwent lobectomy surgery, which was removal of the segment of lung which was afflicted with cancer. Following the surgery (post-lobectomy), the patient developed pneumonia. The CT scan showed patchy broncho-pneumonic patterns unlike that of COVID-19 radiologic findings (ground glass opacities). The patient required ventilation for a prolonged period because of the post- surgical complications. The good news to me as a doctor was that the bacterial culture showed sensitivity to almost all antibiotics and hence the recovery was certain from the bacterial infection. It’s only a matter of few days, or maybe a week for full recovery and maybe another few days, after that discharge from the hospital to continue the next course of cancer directed treatment. On the 5th post-operative day (Day 4) the patient developed an episode of mild fever. For information of lay person, the Day 0 is the day of surgery. Dr Sanjay Kumar, the In-Charge of our hospital ICU instructed the attending nurse to take a nasal swab for COVID-19 testing, just to ensure other patients in the ICU are safe. Voilà, there you go again! The test result came back positive. Again, all hell broke loose in the ICU. Ravi our hospital social worker, you remember right, was immediately pressed into service, to search for a bed in COVID-19 ICU with ventilator facility anywhere in the city.
The mad rush for search began! As a Hospital Administrator, I was also called to service and search for the same. I called Dr. Saktim Baruah, who was In-Charge of dedicated government’s COVID-19 hospitals in the city with ICU support. Dr. Baruah replied that there is not even one ICU bed in any government hospital available across the city on that particular day. However, there were few ICU beds vacant in private hospitals in the city, Dr. Baruah further informed me. The caregiver of the patient with cancer was financially weak and belongs to the under- privileged section of our society and hence couldn’t afford Rupees 20,000 per day for ICU in a private hospital. Just to add here, a private hospital in our city charges between Rupees 3-5 lakh for 10 days stay for COVID-19, yes just for the stay, excluding the ICU charges per day. The golden goose! What a lucrative business model this was! A pandemic raging through and fear mongering at its peak, it leads to hundreds of new admissions of only COVID-19 cases in these hospitals, which translate to lots and lots of money. Imagine the scale of profit by these private hospitals, and it raises an important question, why would these hospital owners and doctors want this madness to end?
Now, I am coming back to the grim and helpless situation of our patient with cancer and healthy sick for the god damn virus. Just to save other patients with cancer in the ICU from the god damn virus, something must be done immediately. I suggested, creating a separate unit within the ICU by drawing curtains and segregating this patient with cancer and continue ventilator support. The news of COVID-19 positive patient with cancer in the ICU reached the attendants of other patients who were admitted there and the situation turned ugly. Finally, the patient with cancer on ventilation was shifted to the Covid Ward without ventilator support.
This was the most tragic moment for me during the entire pandemic. I knew what was going to happen. I was feeling utterly helpless and a sense of disgrace was overwhelming my emotions. Finally, the inevitable happened and the patient succumbed. The death report reads the cause of death as “pneumonia secondary to surgical complication with COVID-19”. I called on Dr.Baruah over phone regarding the mention of COVID-19 in cause of death in the death certificate. I asked why it’s needed to write COVID-19 in the cause of death, when we are certain the death was not due it. He said, we have to keep track of all COVID-19 fatalities. I understand and that’s OK, but why on the cause of death? I asked. Dr. Baruah proudly replied “we have to follow the science”
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