Covid-19 diary

Dealing with illness and death on this level cannot but affect the efficiency of healthcare workers as well as their mental health

“All our times have come, here but now they’re gone
Seasons don’t fear the reaper, nor do the wind, the sun or the rain, we can be like they are

Come on baby, don’t fear the reaper

-Blue Oyster Cult (Don’t Fear) The Reaper

After over a year of dodging, ducking and weaving, the monster finally came to visit us. Even though I work at Lahore’s main Covid-19 referral centre and we have borne the brunt of the entire pandemic in Lahore, my family, and I personally, had, so far, been spared. But this Third Wave of Covid-19 in Lahore seems to be the worst yet. As always, our large teaching hospital, Mayo, Pakistan’s oldest and largest was overwhelmed first. Our Intensive Care Unit (ICU) beds were crammed and with daily admissions outnumbering deaths by at least two to one for weeks now, I was beginning to have serious concerns for my colleagues working in the ICUs and medical wards.

As a psychiatrist with a special interest in end-of-life care and mental health care for doctors and hospital workers, I knew that dealing with illness and death on this level cannot but affect the efficiency of healthcare workers as well as their mental health. I had seen this firsthand last year beginning with myself and some of my closest colleagues and friends.

There was Dr F, the younger sister of one of my medical college class fellows from 30 years ago, now a senior medic in Mayo Hospital. When the pandemic hit Lahore in late February 2020, we had been working on helping her process the grief of losing her father a few months ago (to old age and natural causes). I did not know her well but had always felt some affection towards her since her older sister and I had been class fellows. When she finally reached out to me, her words were, “I need to talk to you, I’m not well.” This was in the pre-Covid era, a time that seems magical and far away now.

Shortly afterwards, we had a long conversation about her grief. Her father had been an eminent surgeon who had loomed large over the medical landscape of Lahore for decades. She was the youngest of four siblings, all brilliant and high achieving and the one who had, it appears, chosen to remain in Lahore with her parents. She was now a senior and highly respected physician herself when Covid hit.

For the last two years of her father’s life, she had been his physician and had been there at the very end. He had literally died in her arms and she was the one who had given the order to her team to let him go.

There is an aphorism in the medical profession that a doctor should never treat him/herself or close family members (or anyone that they cannot keep an ‘emotional distance’ from). Treating those close to you is bad medical practice since you cannot disengage yourself effectively enough to make the sometimes-hard treatment decisions needed. In addition, as taxing as a doctor’s work is, it becomes magnitudes more difficult when the ‘patient’ is close to them, emotionally speaking. All of this is beyond dispute in developed countries and is taught and practiced as such.

In Pakistan, as I had learned the hard way when I moved back from the US in 2010, disentangling the professional and the personal is not so simple. Some of the professional practices and standards that we are taught and that I and my colleagues practiced in the West are not routine. Or at least, not the same way.

All of this is to say that I understood how my friend and colleague had become completely enmeshed in the care of her father’s terminal illness. Her older brother and sister, both doctors, lived abroad. As is the case with many Pakistani families, those living with parents become their designated caretakes, for better or worse.

The story of her last days with him was devastating. Suffice it to say that she was haunted by her failure to ‘save’ him and her identity as a highly qualified, highly respected physician was hanging by a thread. Not to mention her crushing grief as a daughter who had lost her father, someone she loved with all her heart.

I had, rather reluctantly, agreed to try and help her. Reluctantly because of the reasons mentioned above: ‘dual’ treatment relationships (friend-patient, family-patient, patient-spouse, patient-business partner etc) are fraught with problems, many of them in addition to the aforementioned difficulty with ‘emotional distance’.

But I could see that she was in pain and I felt a big brotherly affection towards her so we started working on her grief and its attendant consequences.

And then Covid hit Lahore. The First Wave in Lahore was actually, in retrospect, rather an anti-climax. The number of Covid-19 cases rose slowly; hospitals etc did not get over burdened early and while the fear and panic (including among doctors and healthcare workers) was extreme, the actual outbreak played out rather sedately, or so it seems. We all got a few weeks off work and ‘enjoyed’ the pleasant spring holidays. We also got a respite from Lahore’s choking air pollution since there were hardly any cars on the road. Eventually, the cases peaked and then declined over the next few months.

My friend was, of course, a frontline warrior through all this. We all worried for her as she went without sleep for days while treating dozens of the sickest ICU patients, appeared to hardly eat and seemed to grow gaunt as the summer wore on. Since I was also trying to help her ‘process’ her grief, I worried about how much her frantic caring for dying patients and their families was a way for her to atone for her perceived ‘sin’ of letting her father die.

One night, awake after sehri, I wrote a poem for her:

Demon

The stars shine down

Listless and dim

A gentle breeze stirs

Caressing the half-lit countenances of trees

Wafting over the sleeping streets

The city stirs uneasily

Afraid of its present and fearful of the future

She rolls in her bed, tossing, turning

Tortured by the demons of the night

She dreams of his hand

Reaching out to clasp hers again

They walk together

Past the trees, swaying in the breeze

She feels the sunshine on her face,

The fragrance of his cologne mixes with the heady smell

of Roses and Frangipani

Jasmine and Wisteria

She is a little girl again

Walking hand in hand with him

Tall, elegant, imposing

Towering over her

Covering her being

It overwhelms her

The love she feels, the pain and longing

She feels her chest constricting

The tears beginning to rise,

Even in her sleep

As she begins to wake

The demon wakes beside her

And she feels the terror

She is falling, falling, falling

“Father” she cries out

But all is silence.

She is alone (Lahore May 5, 2020)

A year later, we were again at it: in the middle of Third Wave of Covid-19 in Lahore, the worst one yet. ICU’s and hospitals overwhelmed, positive tests and cases spiking all over the Punjab and across the world and deaths in higher numbers than anyone had ever imagined.

Once again, my friend was in the thick of the battle. Except this time my entire family had just tested positive for Covid-19.

— To be continued—


The writer is a psychiatrist, author of Love and Revolution: Faiz Ahmed Faiz and a Trustee of the Faiz Foundation Trust. He can be reached at [email protected] and tweets @Ali_Madeeh

Covid-19 diary