Patient’s Voice

We continue our new section “Patient’s Voice” with a true story of a nonagenarian patient who was admitted to our hospital with Covid. He was a very cheerful and optimistic person who cheered up other patients in the ward. The title of the story, I could have danced all night, comes from the joyous song sung and danced by Eliza Doolittle, the uneducated flower girl at a London market, who learns English from Prof. Higgins, an expert on Phonetics, the art and science of correct pronunciation of a language, after she passses off for a princess at an embassy ball, a role beautifully played by the late Audrey Hepburn in the movie My fair lady, a stage and screen adaptation of George Bernard Shaw’s Pygmalion.

I could have danced all night

A Covid survival celebration

Admitted with COVID,at the age of ninety-seven, I knew the probability was high that I would leave the ward, feet first.

Age wasa bad card to hold in hand as I negotiated my way through the hospital, contemplating my odds of survival from the new C.

I would learn about many such bad cards during the days that followed. I watched, listened, and sensed the events that happened around me, hoping to acquire an education before time ran out on me.

I shall not repeat the C-word in this essay. In the East, we believe that a name gathers power the more times you say it. Conceived in an exotic animal world, born in a wet market at Wuhan, and delivered to the human as a nasty surprise, this disease has steadily gained enormous power and penetration.

I knew it the second it hit me at the root of my nose. I was in the street market, buying vegetables, with many people around me. When I bent down to collect the vegetables and pay the vendor, it hit me with a ping between the eyes, like a cold always did to me. Later, I learned that this virus is a new relative of the old cold virus, and that ‘when a crowd was present, the virus was also present.’Thus my education began in earnest at a vegetable market.

A few days later, what seemed to be just another cold progressed to sore throat, headache, body ache, and fever. Terrible fatigue came over me, which was never the case with the common cold. I had a dry cough, and my chest did not feel right. All that was usually required to knock out the chill was a hot and spicy soup, but I could neither taste its tanginess, nor could I smell its sharp and spicy flavor.

When I went to consult my GP, I sensed things were different. He gave me a mask, he was wearing one himself, and pointed to a sanitizer dispenser, indicating that I thoroughly sanitize my hands. He gesticulated to keep my hands off the table, keep a distance from him,and pointed out atablet and a touch pen beside my chair. The screen displayed a form that mentioned precisely the symptoms I had, and some more, like breathlessness, diarrhea, and rashes. I ticked the boxes, and I could see that his desktop computer displayed the information to him. His nurse wore a gown, mask, gloves, and a visor. She sanitized the tablet and touch pen that I held, checked my temperature by pointing an instrument at my forehead, counted the rate at which I was breathing, requested me to slip my middle finger into a sleeve, and read out the numbers to the doctor.

At that moment, I knew everything had changed. This was a ‘no touch’ operation, to prevent catching a highly infectious disease. I had learned several lessons since I sensed the ping at the rootof my nose. Later I counted, there were at least twenty that I had just absorbed from my experience with this new disease!

That was also when I heard its name for the first time from my GP. He advised that I should be tested and referred to a hospital. I did not know then that the word ‘test‘ would soon become omnipresent in our lives.

To have a person attired in the fashion of these new times, and negotiating a stick with a swab up the nose was a novel experience. During the interlude I had between the testing and the result, I looked up. I learned what RT-PCR stood for and was fascinated by the process of harvesting and amplifying the genetic material of the virus. When the report came as positive, I knew that there was another word I would hear repeatedly.

The next port of call was the hospital. That was where I learned that the sleeve placed on my finger was a pulse oximeter that measured oxygen levels in my blood. The doctor did not look happy with the numbers but thought I was not unhappy or uncomfortable about my state. He was good enough to educate his junior colleagues and me in the process that I had ‘happy hypoxia.’ That was a new one on me!

I had ‘comorbidities’- age,high blood pressure and coronary artery disease. I watched many coming with more, like diabetes, chronic kidney, lung and other diseases, cancer etc.I learned yet another harsh new word.

It was time for ‘imaging’ and to learn that the CT-scan looks into the lungs most critically as they are the favored destination for the virus and where it makesthe most mischief. I got to hear of scoring systems, and I wondered how I fared. Contrary to what I imagined, high scores were not good.

Lab tests were in order. They looked essentially at two things- whether I was low on useful cells called lymphocytes and whether my immunity was acting up. I heard the intriguing term ‘inflammatory markers. ’I gathered that if they were marked up very high in a very sick patient, that did not bode well. Later, in the wards, I would learn that they rang a warning bell that there was a fire raging in the body,but science did not yet have many good firefighters to douse that.

The time came forthe carersof my health and me to make somedecisions. That began with the admission to the isolation ward.

A strange insight I gathered on meeting my GP, nurse and hospital staff was that this situation was very different in another very unique way. Those who cared for patients with this disease were at greater risk than the patient himself. I was sure they were acutely conscious of it, but their training and state of preparedness gave them extraordinary courage and fortitude to continue to serve regardless. They were professionals who worked as a team; I noted that they did so in pairs and kept a sharp eye on each other to ensure that safety was never compromised when challenged with urgency. Some wore an ‘I am your buddy’ badge on their chest that was heartwarming. That evoked memories; in battle, soldiers watched each other’s backs. That was how we stayed safe from the enemy.

Communication took on a new meaning in the Isolation ward and ICU. Distinguishing between people was not easy, and conversation wasoften not possible. The staff wore large name cards, and sign language and collar mikes made it more convenient and interesting to converse with them.

My doctor, nurse, and I came to a quick agreement that I had pneumonia and needed to get oxygen into my lungs in the most comfortable, safe, and efficient way.

As I began to need more oxygen to breathe, I graduated across the spectrum from the simple nasal prongs to non-invasive ventilation, getting used to methods like non-rebreathing face masks and high-flow nasal oxygen.

I was ‘proned’ from time to time, and I felt it opened up doors to closed spaces in my chest. The ease of breathing became the index of comfort and confidence.

I learned that it was not as simple as getting air to flow into the lungs. There could be a resistance tothe transfer of oxygen to the blood and extracting CO2 in return. The virus clogged the blood vessels, and blood thinners could help. The doctor explained to me in short, precise words that I had no difficulty in understanding. Healing acquired a new meaning when it became a partnership between the hurt and the healer.

It was a novelty to be crisply briefed by a doctor about the drugs.Words equalled time, and the less they spoke, the more time they had to think about all of us on the ward, very ill. I was explained that, besides oxygen, I would be given just three drugs. The first would thin my blood, the secondwas an antiviral, and the last was cortisone, a name familiar to me, which was to tame the inflammation that was setting in and could pose a problem sooner or later. I was assured that the decision was based on the best evidence available and they would be back to discuss if anything better came along. That was it. The confidence and courage that gave me were more potent than the gas and the three drugs together. I felt that, just as a door opened to accommodate me in this laboratory of healing,there was a distinct possibility that a door wouldalso open for me to leave safely.

I was also aware that, if things got worse, I could end up in a room with no view. Some patients could get critically ill, and body systems could fail, falling like dominoes. I heard hushed discussions about ARDS, myocarditis, acute kidney injuries, cytokines, clotting and bleeding, inflammation, and infections. All of them seemed to be dire situations. I gathered that effective therapies were becoming available, but the problem could be a touch and go.

But I was wheeled out sitting, a week later!

I am an old soldier who did not die. But, before I fade away, I hope I shall see this war end. I respect, trust, and support the people fighting this- the government, civil servants, scientists and women and men of the medical profession.

Age was the most significant risk factor for dying from this disease. I managed to avoid endorsing that; I am hoping to live.

In the lobby, I was thankful I could stand up, steady on my feet. I was so happy that, like Eliza Doolittle once sang in my favorite movie My fair lady, I could have danced all night!

I did not have a real home to go back to, it was just me and my carer.

Getting sick wasn’t a good idea, but for a while, I was with a family that cared and comforted me, nursed and fed me, and put me to sleep, making sure I woke up to another morning and another day of my life.

Epilogue:

This is the true story of a remarkable person, who we greatly respect and admire.

It has been re-told by Dr.Venkita Suresh, Group Medical Director, Kauvery Hospitals, who talked to him and developed it further to convey the core messages from the pandemic, for the benefit of all.