New Delhi: Around 4 am on 1 May, Arif Sohaib, an anaesthetist at a private south Delhi hospital, sat in his car and wept.
Minutes ago, he had lost a patient, a woman in her 40s, with dangerously low oxygen saturation levels. She had been brought to the hospital by her 15-year-old son. That same night, another patient, conscious as the 36-year-old doctor inserted the cannula inside her vein, died within minutes of her arrival.
“I wanted to run away, to erase the memories of the last 10 days. Nothing has prepared us doctors and nurses for this kind of trauma,” said Sohaib, over the phone. “We’ve seen ample deaths as healthcare workers but this is something else.”
The second wave of Covid-19 which began in India’s larger cities, such as Mumbai in mid-February, Delhi towards the end of March, and Bangalore in early April, has now spread to the hinterland (see here and here), decimating an overstretched healthcare system.
On 7 May, India reported a record 414,188 new cases in 24 hours. On 12 May, the country recorded its highest single-day death toll: 4,200. By 13 May, 254,197 people had died of Covid-19 in India.
At the Delhi government’s LNJP Hospital, 48-year-old Renu Sharma, a nursing officer, returned to duty barely four days after her nephew and sister-in-law passed away due to Covid. “Pichle saal darr tha, iss saal dukh hai (last year there was fear, this year there is pain),” she said.
Every time she sees a young patient gasping for breath, her “heart breaks”—it’s a reminder of the 36-year-old nephew she lost on 24 April.
The last one month has exposed the cracks in the healthcare system in the national capital—hospitals tweeted about the oxygen shortage; at least 31 people died across two private hospitals (see here and here) from lack of oxygen; families rushed from one hospital to another in search of beds; families posted SOS appeals on social media for oxygen cylinders, medicines, ambulances—even crematoria.
As the national capital reeled under a Covid emergency as the positivity rate shot up to 30%, and hospitals appealed to the Delhi High Court to help resolve an acute oxygen crisis, the pressure on healthcare workers has been tremendous. Article 14 spoke to 13 doctors and nursing officers across Delhi’s hospitals about the impact of the second wave of Covid-19 on their mental and physical well-being.
None of them received institutional help to deal with the grief and trauma they encountered daily at their workplaces.
Inside The Covid Ward
Between working inside the Covid ICU at the All India Institute of Medical Science (AIIMS), where a colleague too was admitted, monitoring the health of his aging Covid-positive parents in Odisha, and attending “over 50 desperate calls for beds, oxygen cylinders” daily—Kalicharan Das, 32, a neuro-anaesthetist, often found himself awake till the wee hours of the morning.
“Last year on Covid duty, I noticed that very few young people needed ventilator support, and even then they would mostly recover. This time, so many young people in their 30s and 40s are dying,” said Das. “Every night I think about all those I couldn’t save.”
Das said his colleague being treated in the AIIMS Covid ICU sent him a WhatsApp message: ‘I am choking.’
“How do you think our mental health is? We are devastated, shattered, broken,” Das said, adding that he had started telling strangers about the deaths he witnessed daily and asking them to wear a mask
Last week, he decided to stop using social media in his free hours, to avoid videos of wailing parents and their grief-stricken children as the virus wreaked havoc across India. “I watch something on Netflix to divert my mind, what else?” he said. Most healthcare workers that Article 14 spoke to said that they had six-hour duty rosters, excluding the time spent donning and doffing PPE suits. Within minutes of wearing the PPE, gloves, boots, mask, goggles and face shield, doctors, nurses and nursing orderlies are drenched in sweat. At the end of the day, the indentations of the tight mask around their face, rashes because of the sweat, and minor injuries caused by the mask’s elastic band remain.
With 32 patients under her care at the LNJP hospital ward, all on oxygen support, and a grieving family back home, nursing officer Renu says there is “no time to look for grief counselling”. She lost four colleagues to Covid—three nursing officers and one lab technician—in less than a week.
“Last week, the oxygen saturation of a patient fell to 56. We did proning, called the doctor, who put her on a BiPap machine until her saturation finally reached 88-89. At 2 pm, my duty finished and I left. At 3.45 pm, I got a call that she had died,” said Renu, in between sobs. “Today, I met her son, as he came to pick up her phone and other belongings. I wanted to cry and tell him that we tried to save her,” Renu Sharma told Article 14 on 3 May.
Like Das, Sharma too stays up till early morning weeping, sometimes for her nephew, and sometimes for her patients.
In April, Pragya Shukla, head of the clinical oncology department at Delhi State Cancer Institute (DSCI), contracted the virus, as did her son. “My own sickness aside, I can’t even keep count of the people I have lost to the virus. There has been no time to grieve,” she said on 3 May, as she returned to duty at the non-Covid hospital. “When the pandemic goes, PTSD (post traumatic stress disorder) will hit us all.”
For two weeks, Shukla, like all her colleagues, fielded calls from friends, family and acquaintances asking about the availability of oxygen beds, cylinders, and medicines. “I am scared now when my phone rings because someone will ask for a bed and I will not be able to help them,” she said. “I feel like a failure. Healthcare workers are psychologically burnt-out.”
Battling A Shortage
Apart from a visible shortage of beds, ambulances, and oxygen cylinders, another crisis Delhi faces is the shortage of healthcare workers, with many across hospitals testing positive.
Santha Sivarajan, a senior nursing officer and head of the nurses’ union at RML Hospital told Article 14 that while there were 1,200 nurses, including 400 on contract, “around 700 are working, as those who are pregnant or lactating, diabetic, or Covid positive cannot work”.
On 4 May, The Hindu reported that the “first batch of 10 nurses from Kasturba Hospital in Manipal left for Delhi to serve at the Manipal Hospital in Delhi’s Dwarka.” The Delhi hospital had requested extra support.
A nursing orderly at a private hospital in Delhi, on condition of anonymity, said that “at least twice,” he had been asked to “stand in a queue outside an oxygen plant to get oxygen.” He said, “I stood for six hours… This is not my job but the hospital was running low on oxygen, so two of us were sent.”
A 24-year-old nursing orderly at a Delhi government hospital, a contract worker, said that he had been ferrying bodies of Covid patients to crematoria. “The first time I went, I saw so many bodies there… Like it was a mela. I came home and cried all night,” he said. “My parents want me to quit my job but I am the only earning member of the family. Who will feed us?”
On 2 May,Juna Wilson, 37, nurse in-charge of the emergency at Maharaja Agrasen Hospital, said that for every bed there were at least two patients, some of them in wheelchairs. Like many of his colleagues, he feared that if he fell sick, there may not be a bed available to accommodate him.
“An ex-colleague, who is now with a well-known private hospital in Delhi, did not get a bed for his Covid positive parents anywhere for days. They finally got admitted here… He’s so senior, and he had to go through so much to get his parents proper care,” said Wilson. “It’s demoralising.”
After 10 days, Wilson’s ex-colleague’s father—who referred to all staff members as “beta”—passed away. Two days later, the deceased’s wife too succumbed. “Imagine, losing your mother and father in two days… What can be more painful?” asked Wilson.
For 39-year-old Naveen, a nursing officer inside the Covid ICU ward at Deen Dayal Upadhyay (DDU) hospital, his seven-year-old daughter is the main source of joy. “As soon as I reach the gates of the hospital, I see hundreds of people desperately looking for beds, and inside we have patients on BiPap machines and ventilators… The atmosphere is grim. We are vaccinated, so that’s a big boost but that doesn’t take away the feeling of loss we encounter daily,” he said, on 3 May.
Recently, when a 32-year-old patient, a well-built gym owner who had been admitted at DDU hospital for three days, started deteriorating, Naveen’s heart sank.
The patient’s brother was made to wear a PPE and brought upstairs to the ward to see him—perhaps, one last time—as doctors and nurses tried to revive him with CPR. “When he died, we just sat in a corner, quietly. We were grieving. 32 is no age to die! He wasn’t even married,” said Naveen.
On 12 May, the positivity rate in the Capital was at 17.03 %. According to official figures, as many as 20,310 people have died of Covid in the last one year in Delhi, although newspaper reports indicate that the figure is higher. “From April 18 to 27, as many as 3,049 died of Covid, and an almost equal number, 3,909, died suspected to have had Covid,” The Indian Express reported on 30 April.
Meanwhile, nursing officer Sivarajan shared Wilson’s fears. “There are no beds kept aside for staffers,” she said. "We have been requesting the administration for a year to do this… What about us, our loved ones?”
Sivarajan, who has worked at RML hospital for 28 years, said that she had “never seen the hospital swamped with patients like this… Not even during the bad dengue outbreaks Delhi has dealt with in the past. Every day, we mourn a different person".
"I wish the administration realised that we need counselling," said Sivarajan. "It’s the next pandemic—mental health crisis of the healthcare workers."
Major Sadhna, a senior anaesthetist who works in the critical care unit at Max Super Speciality hospital, and who has previously served in the Indian army, said this was the “hardest assignment because there is no end to it”.
“In this wave of Covid, those most impacted are between the ages of 20 and 45 years, basically those who haven’t been vaccinated. Post-Covid care for critical patients is a long process, both physically and mentally,” she said. “We almost lost a 35-year-old patient today… His wife told me how they had been married for a decade, about the life they want to lead together… It’s heartbreaking,” said Major Sadhna.
She recalled the life story of a 62-year-old patient in her ward, who recently died due to post-Covid complications, as told to her by the patient’s daughter. “He was a businessman from Rajasthan, who belonged to an orthodox family, and broke many norms to raise and educate his daughters," she said. "When he passed away, I had tears in my eyes.”
“This virus is tricky," said Major Sadhna. "One minute you are doing fine, another minute you are gone.”
After a taxing day at work, Major Sadhna returns to her hotel room in the city. Her nine-year-old daughter is with her in-laws in Hyderabad, while her husband, also a doctor, is posted in Jalandhar. “I haven’t seen them in two months, and will not be meeting them till August,” she said. "Someone has to do the job.”
(Somya Lakhani is a Delhi-based journalist.)