A gastroenterologist’s COVID musings from behind the mask

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I was recently asked to see an 89-year-old woman who was gravely ill in the intensive care unit. She was admitted with cholangitis due to bile duct stones causing complete obstruction leading to septic shock. It is a life-threatening situation, especially in elderly patients. She needed an emergency endoscopic procedure: ERCP. By the way, one minor detail that makes this case more interesting and the intensivist called it a “wrench” was that she was COVID-19 positive.

It took two nurses and 15 minutes for “donning” of my gear. I had to wear a lead gown first (the procedure involves using X-rays), then I had to put on two of each: masks, gowns, gloves, knee-high shoe covers. After that, I had to wear a hood, which was connected by a duct to a motor with a battery pack, belted around my waist to blow cool air into the hood to keep it cool around my head.

I was able to remove the stones, pus, and put a stent to drain the bile. After the procedure, as per protocol, we were not supposed to remove gloves or gown or not leave the room for 18 minutes to let room air to recirculate several cycles. Until I was cleared to leave the room, I stood in the corner of the room with my hands crossed with gloves that were wet with bile and blood.

I tried to strike a friendly conversation with my colleague by asking, “How’s your head AC working,” pointing towards his hood. He could not hear me well as my voice was muffled coming through the hood and he was partially hearing impaired due to the noise of the air circulating around his head.

He replied by asking, “What?”

I said, “Nothing.”

At that point, all I could do was stand there and not talk. Although there are 1,400 minutes every single day, I never complained about how to spend each minute, but when you must do nothing and stare at the clock for 18 minutes, that seemed like an eternity.

I was looking at the patient who was coughing after the breathing tube was removed from her throat. It was unsettling to imagine that I was sitting in the room full of air filled with this microscopic monster that has devastated millions of people all over the world and was only a few millimeters away from my body.

While I stood there in that corner looking through my hood, random thoughts entered my head about how the entire world changed in a matter of days and months. I have never imagined, probably naively, during my medical school, training, and throughout my career until a few months ago that I had to dress like an astronaut to do a procedure.

During this generation-defining, life-changing pandemic, I think one of the best things that happened to the health care field is telemedicine. Telemedicine was not widely adopted (partly due to insurance payments, etc.), although we had the technology to do so for many years. But we made a decade’s worth progress in telemedicine in the first two weeks of the pandemic lockdown.

My father, who is forever technophobic, is now seeing his dermatology patients from home using his mobile phone and WhatsApp. Here I am sitting in one of the most advanced countries in the world, feeling like fully embracing the cutting-edge healthcare, my father is doing pretty much the same thing in a remote part of India.

Another major progress is in the field of vaccinology. There is now potential to make vaccines in a matter of months rather than years, although only time will tell whether these vaccines will be effective and safe. Regardless of whether you are a believer in the vaccine or not, whether it is going to give enough or long-lasting protection or not, just the magnitude of resources spent and the speed of innovation is breathtaking. This shows that necessity is not only the mother of invention but also innovation.

Although wearing a mask all day gave me headaches, runny nose, etc., I have gotten used to it. The choice of wearing a mask vs. not wearing a mask in this country, sadly, has become a political statement, not a public health issue. I think there are a lot of advantages to wearing a mask. I am not talking about the obvious one-saving you from COVID. There are some lesser appreciated perks: You don’t need to wear makeup, no need to shave, or you can curse silently if you don’t like someone. A recent study showed that wearing a mask may work like a vaccine. There is a concept called variolation: a low dose virus that slips through the mask is just high enough to develop immunity and not high enough to cause serious infection. If this proves to be true, there is one more reason to wear the mask.

When this is all over, we will all appreciate simple things that we took for granted for all our lives, such as hanging out with friends, going to movies, flying whenever and wherever we want, not having to wear masks and shields at work, etc. This should give a different perspective on our lives and existence. This too shall pass. The trillion-dollar question is, when?

That elderly patient lived and left the hospital. I saw several COVID patients before, and after her, this patient remains special for all the “wrenches” stacked up against her: COVID-19, serious bloodstream infection, kidney failure, and mild heart attack along the way. Although we didn’t land on the moon in that gear, we did save the patient’s life, which is priceless.

Sripathi​ Kethu is a gastroenterologist.

Image credit: Shutterstock.com

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