The Fighter In Us.

The war is still on, how can we stop,
Our blood is still warm, how can we stop,
Our mission is undone, how can we stop,
The battle is not won, how can we stop…

COVID has taken its toll, we are in pain,
Yet unbroken with the shackles and chain,
Our eyes are in tears, but spirit intact,
The fire in us still burning has its effect…

The fighter in us is raring to go,
We don’t have the time to feel a bit low,
Our hearts still beating, we must move on,
As front line warriors we continue to perform…

PPEs and masks we must carefully don,
And fight until the threat is all gone,
God will favor the mighty is our belief,
Until we breathe our last sigh of relief…

Sarvodaya Hospital In Times of Corona…

With the country grappling with the unprecedented changes brought by the Covid 19 pandemic, the last couple of months have forced major changes in the healthcare sector. Though the entire world realized that we had underestimated the destructive capability of the virus, and were left unprepared, India showed resilience and courage to boldly face the grim situation.

The realization that it is not a matter of ‘if’ but ‘when’, the pandemic was going to hit the country, compelled us to think long and hard, requiring activation of a disaster like situation, with hospitals getting very little time to prepare. Sarvodaya Hospital & Research Centre in Faridabad, was one such corporate hospital which was at the forefront in Delhi-NCR region, in terms of its preparation to deal with the current crisis.

It all started with creation of a Covid Core Committee comprising of experts from all clinical & non clinical fields to brainstorm on the way forward including laying down the policy, resource management and delegation of work.

The 1st step was creation of a Flu Corner outside the 2 main entrances of the hospital for thermal screening of patients & their relatives. Patients presenting to the Emergency department were then triaged again, using a specially created visual triage checklist, based on their symptoms at a triaging desk manned by a trained emergency physician. A separate isolation area was created within the Emergency, with a dedicated nurse and separate portable Xray, ECG and Sonography machine. Standard treatment sheet for Out patient & In patient management of suspected patients was created, so that patients could be treated based on whether their symptoms were mild, moderate or severe. At the same time, patients who were advised home isolation were handed over specially designed patient education & awareness brochures from the Emergency & the OPDs. A specially designed sample collection booth was also made, to collect the swab samples of patients, thereby ensuring zero contact with aerosols & minimizing risk to the nurse collecting the samples.

A separate Isolation ward was created, and the High Dependency Unit (HDU) was converted into the Corona Care Unit for admitting suspected cases. Patients were transferred from the Emergency Isolation room to the respective IP areas directly through designated lifts. Patient wards which were not needed were also closed, to provide a backup reservoir if there were too many cases.

Since the OPDs were closed initially and all non essential services had to be stopped, the hospital made arrangements of video consultation and tele-consultation for the patients with their primary physicians. Once the OPDs were permitted for few hours a day, the hospital made all arrangements to restrict the number of visitors with the patients, introduced a token system to meet the doctor and also the waiting area seats were numbered to follow social distancing norms. Similar process was followed at the other support service areas like the pharmacy, laboratory & the radiology departments. The security department in the hospital was proactive to make sure that there was a smooth movement of patients and that they were guided properly. The Consultants were also provided Level 2 PPEs and maintained social distancing while attending to OPD patients.

To keep the hospital machinery functional, similar arrangements were made for the Operation theatres, Endoscopies, Labor room where doctors & nurses were provided with complete protective equipment. Patients were counseled & screened for COVID before undergoing any procedures.

Under the watchful eyes of the Microbiologists and the infection control nurses, a detailed COVID infection control policy was also made which was regularly updated as per the dynamic government guidelines. The department was also responsible for training and monitoring of all hospital staff for compliance of the policy. Their other responsibility was tracing of all reports, everyday, from the government approved laboratories that the hospital had tied up with for COVID sampling. The patients whose test came positives were immediately referred to the ESI hospital & Medical College as per the guidelines of the state government, in the hospital ambulance, where even the driver and support staffs were provided with Full PPE hazmat suits.

The hospital was very prompt in its actions and was successful in the mammoth task of procuring the recommended N 95 masks, 3 ply masks, PPE kits; even to the extent of procuring raw materials and having in house tailors stitch protective gear, round the clock. Thankfully, there has been no dearth of any protective equipment to any of the hospital staff. A lot of credit should be given to the purchase department which went out of the way to procure things, day in and day out, since the supply chain of the hospital was broken due to the lockdown.

All hospital staff was also allotted duties on a rotational basis so that a backup team was always ready, if an entire team on a shift needed to be quarantined. The hospital also made all arrangements to quarantine the doctors and nurses in isolation rooms within the hospital premises and the hostels.

Regular patient education and awareness information, training videos were created for the patients and widely shared on the hospital’s social media platforms as well.

Understanding the importance of mental health, the hospital has continued regular counseling of all the frontline staff, conducting stress management activities to keep the morale high of all its employees in such testing times.

Though it is sad that it took a pandemic to lay bare our vulnerabilities and forced us to radically revamp the way healthcare is delivered, but we must look towards the future. We, at Sarvodaya Hospital & Research Centre, Faridabad, are fully prepared and committed to providing the best care to all our patients in times of this pandemic. We sincerely hope that our collective efforts shall not go in vain and the lessons learnt from this pandemic will eventually make our systems more resilient in its aftermath. Hopefully soon.

The Truth Behind the Numbers.

A 35 year old male is brought dead to the Emergency Department with history of fever since 2 days, associated with cough and breathlessness. The doctor in the emergency explain to the patient's relatives that a Medico-legal case needs to be made, since it is unnatural for a young patient without any co-morbidities to suddenly die, and the body might be sent for post mortem by the police. Scared, the relatives decide to take the ‘body’ to a government hospital, as they know that there would be less chances of going through these legal hassles to get a ‘Non-Covid’ death certificate.

It is not a fictional story my friends, it is a real life incident, with similar instances happening daily, all across the country.

I was surprised to read a news article today, about another young death. “He died due to cardiac arrest and not by coronavirus, though he had tested positive for the infection,” a spokesperson for the hospital told – read one of the paragraphs.

And I thought that the truth needs to be told, the truth about the inhumane side of this pandemic – the big fudging of numbers. It is just the tip of the iceberg.

Similar to the above mentioned incident, I'm sure there are hundreds and may be thousand others all across the country, EVERYDAY, who are SHOWN as dying of cardiac arrest / cardio respiratory arrest / Acute myocardial infarction / pneumonia / infective exacerbation of COPD, Asthma or ILD (lung pathology), etc on their death certificate - because people in India will not die of the coronavirus even after testing positive for it. This is precisely how actual number of deaths is being and will continue to be manipulated. Hospitals are being directed to not write COVID as cause of death, and those deaths which are being reported as COVID need to be 'audited' by a government committee first before inclusion in official numbers released by the state. A notice from the Bengal government was widely shared on social media which clearly asked doctors to NOT WRITE COVID 19 on the death certificate of patients.

If a private hospital reports a death due to COVID, it will be sealed by the government, leading to shut down of the facility. All existing admitted patients need to be discharged within 48 hours or referred to other hospitals, most staff will then be placed under 14-21 day quarantine, patients will be scared to come to that hospital once it reopens, etc – causing huge financial losses to an already hardly hit healthcare sector, where revenue has reduced by almost 70 % due to reduced patient load and reduced surgical procedures. This is the crux of the death certificate.

There are instances when positive reports are not disclosed to the family members, attending doctors and nurses treating these patients to avoid panic among other staff members and patients. Reports are repeated again and again, claiming that the original report was a ‘false positive’ and subsequent repeated report, which actually may be a ‘false negative’ will then be considered as the final report.

The other aspects of this harsh truth for the hospitals is, if they write death due to COVID on the death certificate and the body needs to be taken out of the district for the last rights, the police does not give the mandatory No Objection Certificate (NOC) for transport as it will then increase their work to trace contacts. If the hospital asks for a post morten to ascertain the cause of unnatural–suspected death due to COVID, police again make the doctor write ‘something’ at least in the death certificate to avoid handling and roaming around with a dead body, arrange for a COVID test of the death body, and wait to complete paperwork formalities till the test results come.

Many a times, there are tie ups of the policemen with few general practitioners / quacks who issue such death certificates (off course for a charge), in case a hospital refuses to give one. This reduces the hassles for the police as well, especially when we are dealing with a time when even the relatives are also scared of taking away a dead body.

Besides, not even 10 % of the actual funds released by the government for supporting healthcare facilities or the poor would actually be percolating, with major portion of it ‘disappearing’ between the middleman and the babus.

Without such tactics, it truly would be IMPOSSIBLE for a densely populated country like ours, and with the MORONIC CITIZENS (who can forget the thalis, talis, diwalis, etc), to have such low fatality rates.

Maa, Meri Maa...

On Mother's Day, sharing the story of my patient admitted in the ICU and her young son while I was posted in the ICU as part of my residency many years back.

It has been days since she was brought in an unresponsive state, found to be in asytole...CPR given...had a Ventricular tachycardia...Given DC shock...reverted...intubated...and shifted to the ICU...now ALIVE..with tracheostomy, on life support...but sadly her neurological outcome is poor.

The son could not see his mother suffer anymore, and signed the DNR (Do Not Resuscitate) yesterday...All these days, it was heart touching to see him try talking to her, get his cheek near her lips so that she could give him one kiss like she always used to before...an ideal loving, caring son...This note placed next to her says it all.

The reason I share this is because there is so much we have to express to a person we love, be it out Grandparents, Parents, Siblings, Friends, Lover, etc....but we never do or we never feel the need to, as it is understood or we take it for granted...it is only after they go far away or we lose them that we realize we had so much to say to them.

Friends, if this touches you, make sure to TELL the people who you love what they mean to you (instead of updating your status on FB on those Mother's/ Father's Days, etc)...how much you care for them..how beautiful life has been with them..see old photo albums together..relieve the memories..laugh..cry..cherish the moments..and LET THEM KNOW HOW MUCH YOU LOVE THEM...before its too late...and all you are left with is guilt or regret that, "I wish I would have told..."

This is what it says:
MOM YOU ARE SPECIAL.
You have been the essence of my life even before I opened my eyes to this beautiful world. You tender touch and loving gestures still make me feel warm, secure and dearly loved. Mom, as I look back upon the years gone by, life has always been blissful in the shade of your love.

Today, I would like to thank you for all your little acts of greatness, when you added your magical touch to my small but significant steps in life. You've always encouraged me and lent a helping hand whenever I lost my confidence and instilled the thought that I could overcome just about everything.

You make me realize that I could count on you anywhere, anytime. I may not have thanked you enough but I want you to know that you are my most prized gift from God. You are my divine angel.

I LOVE YOU MOM.

In Solidarity with the Doctors...

“We, the unwilling, led by the unknowing, are doing the impossible, for the ungrateful. We have done so much, for so long, with so little. We are now expected to do anything, with nothing.” – A Doctor on the frontline.

The insensitive videos being shared on social media from my Alma Mater - Sion Hospital in Mumbai, about dead bodies being kept in the ward area where patients are treated is deeply disturbing. The politics and blame game we are seeing now rubs salt on the injuries of my fraternity – The Doctors & Healthcare Professionals – who are The wounded healers.

I and my fellow colleagues no longer wish to be called a corona ‘warrior’. A warrior is taken care of by his command, but unfortunately, all I see here is threat and intimidation by the government, the media and the people who have been mere silent spectators over the last few weeks.

The writing is clear on the wall, it is time now for us to brace for the worst. Looking at the way the numbers are increasing, every day, and the government being absolutely clueless on how to deal with the situation, only a miracle can save us all now from the impending doom.

Where were all the ‘warrior’ calling people when doctors and healthcare professionals were attacked week after week, year after year? Where were those, when doctors complained of the pathetic living conditions, poor facilities at the government hospitals, long working hours, being mistreated by seniors, etc. Silently going along with your own life, because it did not matter to you? And yes, the attacks on doctors, police and CRPF jawans have continued till date.

Now, when we are all on the back foot, what do the people do? Hail the courage of the very doctors who till now were their punching bags and enemy number 1 for everyone, right?

Fact is, like me, most of my doctor colleagues are also scared. And those who say they’re not, ARE LYING.

I want everyone reading this post to seriously think about a few things -

1. With poor quality PPEs on the offering and unavailability of proper N95 masks, do you think doctors and nurses would really want to join the combat, unarmed, like a scapegoat? Do you think anyone likes to endanger their own lives and killing themselves, just for money?

2. What responsibility is the government taking of resident doctors who test positive for the coronavirus while being on the frontline? We have all seen images and screenshots of doctors begging to be admitted in hospital after testing positive.

3. Resident doctors are being denied tests for themselves, even if they show symptoms and are forced to continue to work, putting hundreds of others are risk.

4. The government has not even taken care of the basic food requirement of doctors and nurses on COVID duties. They are not being given a decent meal, the food of the corona patients is better than what the doctors and nurses receive.

5. Where are all the hidden AYUSH doctors who were till now claiming to be equivalent to MBBS doctors? We need you to come join us in the screening of patients, collecting their throat swabs, providing emergency and critical care to the positive patients in government and private hospitals. Why have 99 % of you not applied to the job openings issued by the government in various newspapers?

6. It is simply STUPID to read how the AYUSH ministry wants to conduct research on this pandemic when the world population is fighting to survive. Do you really believe ayurvedic, homeopathic or herbal medicines have a cure for this?

The government has also been misguiding people, having their priorities wrong. Jal Shakti Ministry wants ICMR to conduct clinical trials on use of Ganga Water to treat COVID patient, wow…really?

7. Rs. 50 crore is spent in the fly past on a single day to salute the Corona Warriors by showering flower petals? Who gives all these dumb ideas? The money could have been used for providing food to the poor, PPEs to HCWs, transporting migrant workers, etc. The way it was planned, with people standing in a pattern, raising their 1 hand, looked like another scripted marketing gimmick, and copied from the US.

8. How many agree of the decision by the government to open wine shops across the country? We all have seen how social distancing has gone for a toss, and people are standing in 3-4 kilometer long ques to get booze. Give us one good reason why we should risk our lives to save these morons.

9. I am also interested to know how the donations to the tune of Rs. 7000 crores in the PM Cares fund are being spent. Why is the government reluctant for an audit of the donations in it, by now calling it a private fund? It is all civilian money and we have the right to know. Was there really a need for a separate fund when there were hundreds of crores already lying unused in the PM National Relief fund?

10. And to make things work, the government wants to mandatorily, not voluntarily, deduct salaries of the doctors working on the front line towards the PM cares fund.

11. The government ‘watch dog’ keeps claiming we are not in the stage of community transmission. With close to 4000 positive cases reported a day, all over the country, what else would count as community transmission. Why are we living in this denial being portrayed by the government? Another bottomline is that we are not testing enough! Period.

12. Where is Anjan Om Kashyap? I really want to see you reporting live from a COVID ICU how relatives are not being allowed to meet their patients, and how doctors are not attending to patients. It sure will boost up your TRPs. And do remember to wear the precious PPEs that you and the sold media morons like you are using to report live.

13. No food was or is being provided by the government to the migrant workers? All I see are NGOs and individuals rising to the occasion. The Shramik express trains have been now stopped in many states – the reason, it will be difficult for the economic revival of the state post lockdown, factories will not restart, construction worker will stall, etc. Why did you not act on it earlier, migrant workers walking hundreds and thousands of kilometers to their native place, some even dying on the way, was for everyone to see. And the central government claims that they paid 85 % of the travel cost, and the state government paid 15 %, really? You think we are fools?

14. Medical colleges in South India have hiked post graduation fees by almost double, to cover the cost of the loss due to sparse number of patients. Why? Where do you think students will be able to pay up, with everyone’s source of income coming to a standstill?

15.  And to make matters worse, doctors are not being allowed to stay in their own homes, with their own families, as scared society members have given ultimatum to find temporary accommodation near place of work. These are the same people who would call up the doctor in society, even at odd hours, for prescriptions or free medicine samples.

It is really sad to see such things and still no one has the guts to question the action by the central or the state governments. It is easy to now blame the hospital administration and play the dirty politics for the state government’s own failure.

It is high time they realize that they need to focus on education and healthcare 1st in all their future political agendas, and not Hindu Muslim vote bank politics.

The Murdered Suicide.

Warning: Graphic Image. 

Some stories remain untold, and there are some stories which trouble your subconscious mind, so much so that it would be a crime if the truth is buried.

We doctors, especially those working in the Emergency deal with medico-legal cases on a daily basis, and are used to clicking photographs of the injuries or identification marks of our patients (including those brought dead) to capture them in detail on our doctor notes and the police information report, or to send them to the surgeons on Whatsapp to give them a rough idea of what they would be operating on, before we dress the wounds.

Though I had deleted this photograph multiple times in the past, I’m not sure how I always find it in my old unused phones, computer backup, cloud, etc - as if the dead wants me to tell the truth, the harsh reality of his life.

A 17 year old male was rushed to my Emergency Department in an unconscious, unresponsive state with no recordable pulse, blood pressure or any spontaneous respiration, pupils were bilaterally 5 millimetre dilated and non reactive to light, with his T-shirt soaked in blood.

But since his body was warm, we started with immediate resuscitation (all life saving measures) including Cardio Pulmonary Resuscitation (CPR-Chest compressions), Intubation (putting a tube through the mouth, directly in the wind pipe, to give breaths) and life saving drugs. And I realized that with every chest compression, the soakage on the T-shirt was increasing. I asked my nurse to lift the T-shirt, and what we then saw were 3 stab marks on the chest and abdomen.

To control the further loss of blood, I thought of plugging the stab wound (closest to the chest) from which blood clots were coming out of, during each chest compression. I then put my gloved index finger in it, and I knew immediately that it was all the way INSIDE HIS HEART.

I then ordered my team to immediately stop resuscitative attempts, as we knew that no matter how hard we tried, the patient was dead and there was no way he could be revived.

While the nurses were taking out an ECG, which would show a FLAT LINE (to declare the patient dead), I came out from behind the curtains to talk to the scared father, to counsel him regarding the prognosis, and the mandatory documentation including the process of informing the police.

“I’m a professor at ______ (a very prestigious institute in Mumbai) and he is my adopted son. My elder daughter and he had a fight over her social media posts after which in a fit of rage, she stabbed him with a kitchen knife. We took him to a nearby private nursing home, but looking at his condition, they referred us to your hospital. My daughter accompanied us to that hospital, don’t know where she is now”, the panicked father said, without me even inquiring what had happened.

I asked him to calm down, gave him a glass of water. By this time, I had the Flat Line ECG in my had which showed that there was no activity of the heart, and I pronounced him dead – a news that I always hate to break to relatives of any patient, and especially to a parent about their young child. I then proceeded to complete my paper work.

By this time, more of his family members had gathered in the Emergency waiting area, counseled the grieving father.

After 15 minutes, the father again came to me, this time with 2 other gentleman in their 60s, and they wanted to see my hospital documentation. I explained to him that all I had documented was the patient’s clinical condition on arrival, his injury marks, details of our resuscitation efforts, and not the history that he had told me.

“I never told you anything, what are you talking about?”, said the father and I’m left shell shocked.

Knowing that it was the job of the police to investigate, I did not argue much. I informed my medical director of the developments, and he too asked me to leave it to the police to investigate.

When the police came, I handed them the copy of all the relevant documents, informed them verbally of what the father had initially told me, and they reassured me that they would conduct a fair investigation. The body was handed over to them for further formalities and a post mortem at a nearby government hospital.

3 days later, I called up the investigating officer, to inquire about the progress of the case, and I received another shock. He told me that the child was suffering from depression and had committed suicide. Case closed.

And to this day, I can't stop thinking about precisely these things :-

a) The Professor changed his statements after being coached by his family and friends. Now that his son was already dead, did he want the daughter to land up behind bars for many years?

b) Was it because the son was adopted and not his real son, that the father did not even shed a tear, while he was busy thinking how he would brush the truth under the carpet?

c) The police would have been paid off well, to do what they are best known for… (will leave it to the imagination of the reader. A pointer can be the similar investigation, like that of the famous Salman Khan hit and run case) – a clear case of murder was converted into a case of suicide.

d) You do not have to be a forensic medicine specialist to know that it is IMPOSSIBLE to stab yourself like that, THRICE, to commit suicide.

e) Because of a system that can be manipulated, bribed and bought easily, a MURDERER IS OUT ON THE LOOSE.

My version of this story will NEVER CHANGE; as I know what I had heard that day from the father.

I really hope that the photograph no longer find its way back on any of my screens this time, but would want it to show up on your screens, so that the real story and the harsh truth of the boy can be told and shared with the world.