2 weeks: a case from India
2 weeks: a case from India Ankur Verma opens the podcast by telling his listeners that he’s going to share with them something that happened during the time that Delta was in its dreadful stages in both Australia and India. He goes on to talk about a case that took place during the Delta wave, when minutes matter. He recounts a patient - Mrs P - who had come in gasping and immediately went into cardiac arrest, and notes that – as is often the case – she immediately became part of the ward’s family. After testing positive for Covid, they then gave her a CT scan to see if she had pneumonia and subsequently put her on various experimental medications, including steroids. She got better over the next four or five days and was weaned off the ventilator and over the next couple of days we removed her TPI (trigger point injection) but then her sugars went up. Ankur explains that just when he thought she was becoming much better, she started becoming hypoxic again and he then found out her left lung had collapsed. She then went on to improve – and, understandably – her family were thrilled, especially her son. After a two-week rollercoaster ride, she was discharged, much to the joy of everyone involved. At a time of great distress, Ankur explains that Mrs P reminded him and his co-workers of the power of determination and motivation, and it was through a combination of compassion and great determination and motivation that she survived. He notes that Mrs P gave the hospital staff a ray of hope and a much-needed silver lining during what was an otherwise hellish Covid wave, and notes that he owed her more than she owed him for saving her life. But, continues Ankur, she had other plans. She had been a ray of hope during the dreadful delta in India and the world and sadly, she died. But Ankur says that he and his co-workers didn’t lose sight of the vision and the hope that she gave them and that they continued to support each other. He concludes the podcast with an important lesson learnt: take care of yourself and those around you because when the dark times come, those people will be the ones surrounding you.
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2 weeks: a case from India
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Editor's Notes
- Hello Nervous Always wanted to attend. Superstars of EM. Cliff, Simon, Scott, Jesse, Natalie, Vic Brazil and others Story from the Dreaded second wave in India. Delta variant. The story was also published in the book When Minutes Matter which was released at the ICEM a few months back
- This is a story of Mrs P, A 55 year old lady, brought in a gasping state to our department one early morning by her family who crashed as soon as we took her onto the bed. CPR was initiated and in about 10 minutes ROSC was achieved. She was not responsive and did not have spontaneous breaths so was intubated and ventilated. I felt proud of my team. They hadn’t shut their eyes for a second while on duty, and they decided to stay back to help me care for this patient. COVID had made our team even closer. In some respects, we had become more like a tight-knit family than work colleagues.
- This is what the cardiac monitor and ecg showed post ROSC. She was started on TCP and Plans were made to shift her immediately to the cath lab for a temporary pacemaker implantation.
- But before we could shift her out, her covid antigen came out to be positive. The cath lab was not ready to take covid positive patients. So it was left upto the ED team to do the needful. And we did.
- We got Her an HRCT chest which confirmed she had covid pneumonia.. - probably the deadly delta variant. She was started on all the meds that were in vogue at the time along with other supportive care. She received Remdesivir and steroids.
- The critical shortage of beds during the second wave meant that she would be boarding with us for a while. There were no ICU beds. Over the next 2-3 days of the “covid” treatments she got better. Weaned off. Extubated. TPI stopped and removed. But steroids and other meds – DKA, Hypernatremia. Dialysed.
- Just when we thought things were starting to get better, Mrs P decided to surprise us. During one dialysis session she became breathless again and her oxygen levels plummeted. An x-ray showed that her left lung had collapsed probably due to mucous plugs in her lungs.
- So we immediately got a bronch done which removed the mucous plugs and Her O2 sats and x-ray subsequently improved.
- Once we felt that she was out of the woods, we could have shifted her to a ward bed. Consults - Cardio, Pulmo, Medicine, Nephro, Psych, Endo. But we took care of her 24/7. She had become ‘our’ patient, and her care trajectory was positive. We wanted to witness the ‘fruits of our labor’. Her family, especially her son, was very satisfied with our team’s care, and requested that she be discharged directly from the ED when ready.
- But then we noted that she would not follow our commands or respond to us. We felt she was getting depressed and figured she was missing her family. So we got her son in full PPE to come in thrice a day to feed his mother and talk to her and plan his sister’s wedding. We got psychological sessions and physiotherapy done for her in our department itself. She quickly recovered and became cheerful and started talking to us…
- At a time of great distress, Mrs P reminded us of the power of determination. Her situation initially seemed impossible. But the combination of personal willpower, family support and deep commitment of staff ensured recovery in the most challenging of circumstances. Pace of recovery quickened, Discharged after more than 14 days in our department. As expected, her family were ecstatic that she survived the ordeal. So were we. .
- Emergency departments were never designed to care for patients for extended periods of time. Sometimes, “exceptional situations call for exceptional responses.” This was one of those occasions. The second COVID wave in India took a lot from us, but Mrs P gave us hope. Among all the death and despair of that torrid period, we found a reason to keep going. We owed her much more than she owed us.
- BUT she had other plans…she was back with us after about 5 days. And she was SICK. She was dyspneic, high sugars, acidotic, desatting, in shock…
- And she very quickly deteriorated. We just did not see this coming.
- And then just like that, she switched off. She left us.
- She left us and We were heart broken. Couldn’t believe it. She was a ray of hope in the midst of the crazy second wave and we lost her. But we did not lose sight of the hope she gave us.. I remember Cliff Reid in 2016 in SMACC said – “To look after yourselves, but look after others – they will help and support you during the dark times.”As a team and as a family we came closer. We discussed her case, we talked to each other, we held hands out for each other and did not let any of us get lost in the abyss. But I still look back and think about her. She will remain one of those patients who stay with you for your lifetime….