Unmasking the faces of COVID: pages from a neurologist’s diary

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“Please don’t go just yet. Promise you will come to see me again?” she asked, with a frail quiver in her voice.

“But of course, see you on my rounds tomorrow!” I replied, trying to sound cheery, as I turned to leave her negative pressure ICU room. I was doubtful if she would even remember my masked-gowned presence by the next day or even the next moment. For COVID with its lack of oxygen from her lungs had worsened her dementia.

“I’m sorry, we all look like zombies these days.”

I hoped to calm her anxiety in her lonely room.

“Don’t worry, doc, I will remember your voice and your eyes through that mask!”

Her words touched my core, and I stifled my eyes from moistening as I paused in the hallway. It was these little things, in this shroud of a pandemic, our patients beckoning to us with a sense of recognition even underneath her face.

The face of uncertainty amidst lost and aging neurons and crowned by her silver-white hair.

I made my way to another room. A young human languished for weeks on the ventilator as the viral grasp drowned her lungs, proceeding to melt and bleed her brain and slowly vanishing her persona into oblivion. While passively moving those limbs during methodical neurological exams, I couldn’t help but notice her well-manicured nails. Telltale signs of a carefree, happier, not too long ago past. That minimally conscious state shrouded over my loud calls and sternal rubs, those eyes stared back stone-cold into mine. The lights were on, but no one was home.

The face of blank lifelessness.

COVID was ominously not only drowning people in their own spit but struck in different shades to alter human personality that kept helplessly getting lost in the maze of their own minds. It made the young maniacal, hearing voices and talking to walls in a schizophrenic frenzy. It made the elderly become muted in silence.

The face of helpless madness. Every now and then, the balm of soothing whispers would lull them to slowly break free from this trance.

This strange malady kept fogging up brains behind the faces. Faces of disintegrating seizures. Faces staring into oblivion. My penlight shining down dark pupillary tunnels, in vain, felt futile.

And then there were other faces. Of hospital caregivers, faithfully grooming seemingly lifeless bodies. I would feel enriched when they shared on my rounds, updates from up close, and personal patient care moments.

“Dr. C, your coma patient, I applied lotion on her arms, and a tear rolled down her eyes. Does that mean anything?”

Faces of relentless optimism.

Patients would come and go. Some got better and left for home or off to a humble abode. Harder still was to comprehend the minds of families driven to make incomprehensible decisions on behalf of their loved ones. For those who may never see the next starry nightfall or golden sunrise. All while trusting us strangers through a glass screen of a window or smartphone. Despite numerous end-of-life decisions, the conversations never got old. Providing comfort to them, sometimes was all that we could hope for and, in many instances, all that we often were striving for.

Their faces of grief met with our faces of empathy, conjoining humans on both sides of the screen, wishfully hoping life would turn around and death would walk away.

Faces loomed in my thoughts long after rounds were over and became etched in my memory. Over nearly a year, and what seemed like an eternity, what began as one Covid unit in each hospital, spread its claws to nearly entire buildings. Husband-wife, family clusters, reflecting the aftermath of forbidden celebrations that had deferred countless warnings. The number spikes on TV news never truly reflected the Faces behind the scenes, the true burden of Covid. Now, we tell their tales to honor them. Lonesomeness being their common denominator.

Honoring them would not be complete without a mention of those Faces of ICU teams. Seemingly steadfast amidst countless resuscitation codes. Backbreaking (literal and figurative) hours of weightlifting tasks to prone over heavy bodies in “tummy time” with the hope of recovering drowning lungs. The science of neurology handheld with critical care medicine with a “train of four” to help find the sweet spot of muscular atony before artificially paralyzing the agitated body allowing sick lungs to coordinate sucking life breath from the ventilator. With literally all hands-on deck of what often felt like a sinking ship, we heartbreakingly witnessed tips of this pandemic iceberg shatter us all while attempting to steer humanity ashore to safety.  Hidden under masks, faces of brazen fortitude fed off each other with a healing power of company of another human spirit. The unspoken language of empathy is expressed through our eyes in fleeting moments of time.  Unforgettable treasures that kept us going more than we may ever realize.

Lessons from pandemic diaries applied to life at large. Where people realize that trust in science and the power of their own selves as frontlines, and us healthcare workers as their last lines, will perpetuate the greater common good even beyond the pandemic. A combination of ethics and empathy across specialties and communities helps get us through future adversity.

“Practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

Well played brilliant Oslerisms for keeping me going through the storm. Someone rightly once said, “To remember is to heal.” And I learned more than ever to pause and validate the story behind each silent struggle, the face, behind the mask, the face, a window reflecting intangible connections that lay between the head and the heart.

Ayushi Chugh is a neurologist.

Image credit: Shutterstock.com

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