SURVIVING COVID- A recovered Dr's account

I heard,read,talked about the covid pandemic, till it hit home. Till I exeprienced it myself it was something that would happen to someone else, not me. Denial helps us to keep anxiety at bay but denial also keeps reality at bay.

First when my 78 years old  father was diagnosed as covid positive, l already developed my first  bout of fever spike. Getting a bed for my father was a task in itself , with me lying in the back seat of the car shivering with chills, helpless, not knowing whether my father would be shifted from a non-covid to a covid hospital or what awaits me in the next 20 days.

With admission of my father in a  a covid hospital, and simultaneously my symptomatic condition progressing, slowly time started seeming unreal. Father's condition was deteriorating and mine too. My husband, Sujit transformed our bedroom to ICU. Talking to physician friends, whose immense help and guidance helped him to sustain me at home for almost 9 days. Then on the 10th day, my condition deteriorated. I was in such a fogged state of mind with my father's condition going downhill and my own general medical condition seeming to go downhill. Finally sujit decided to get me admitted. He and his close friend drove me around in the car calling doctors, friends anf acquantainces in search of a bed for at least 6 hours . I was sitting like a dead body in the car listening to the concersations these two were making  trying desperately for a bed  Finally a friend (Dr Vikrant Shah) managed to secure a bed in Surana hospital in chembur. I remember myself sitting at at around 2 am or so, on a chair at the hospital gate, totally unaware what part of Mumbai it would be. Iin the darkness and  silence of the night I wondered if I would just probably sit there forever.  Sujit did the formalities of getting me admitted. As no relative was allowed inside the hospital premises, finally a wardboy escorted me inside the hospital, leaving behind my dear ones, as if I am entering some unknown strange place totally secluded from the rest of the world. I turned back to Sujit  and our friend again and again and bade them goodbye with weak gestures till they disappeared from my sight.

The moment I entered the hospital building at around 3 am, a ppe donned exhausted doctor standing at thhe elevator enquired about me. He took my history in short, and that was the first time I realised i could not speak a word without getting breathless. I had not spoken for so many days due to fever, bodycahe, dullness that I didn't realise that I was breathless. The doctor patted my shoulder and said not to worry, told the wardboy to take me to my room, told me he would meet me in the morning.

It was around 3:30 am. 27th may 2020

I was kept in a single room. The staff came, put iv, checked all my parameters, took blood for testing. The rmo Dr. Vikas came and attended to me. It all seemed unreal. I was put on oxygen. That morning I tried to sleep but couldn't,  but felt safe that I was in a hospital.

From next day onwards, as things started sinking in, as I got more aware of my breathlessness,I started assimilating things around me, inside me,  my being alone in a hospital , with no one by my side, with no one to hold my hand, no one to put hand on my forehead, an altogether different reality started developing. And the last straw on camel's back was the news that my dad passed away.

I felt the gravity of one singular reality, being alone, unable to breath, face to face with death,my dad's, my own. As evening light seeped through the huge window of my hospital room, I started experiencing darkness more intently than ever. Light was sustaining me to face my fears in the daytime but as night approached, the fear of death and darkness would a start a dance in my mind ,an eternal dance of life and death.

My ears would crave for the slightest human existence around me. The staff going about  doing their tasks outside, someone talking down the road, someone's steps approaching my room. I realised how important human company is, especially in a situation where uncertainty rules  and one is on the verge of life and death and all alone. That night I sudeenly woke up startled, at around 1 am and panicked. The oxygen mask , my saviour seemed like someone holding my mouth, not allowing me to breathe. A panic attack...I called the nurse and the staff of the hospital stood beside me holding my hand and I shall never forget that comforting touch ever in my life. The staff was in ppe, I didn't know the person, I knew only one thing, I have someone to hold my hand when my morale, mental strength, physical strength had hit rock bottom. All barriers of self and other disappeared. A feeling of calm dawned upon me.

My treating doctor Dr Sameer had been so encouraging throughout my journey that I cannot thank him enough. He himself used to be exhausted when he would come at around11 pm for his rounds. But relentlessly, without a  frown of irritation or annoyance he would encourage me to do the prone awake position to improve the perfusion of lower parts of lungs, guide me through the progress I am making and then talk to Sujit on phone to give him the updates of my progress. What  a blessing he had been through out this journey I made! I ssurrendered myself to my doctor. I trusted that whatever he would do would be the best for me and i don't have to worry about any medical apsects of mine. In fact, I deleted the fact from my mind that I am a doctor. I was just a sick living being wishing to live.  I experienced first hand how doctors are the frontline warriors in this pandemic along with  their team of nursing staff. How their lives need to be protected with right protective gears and why it is so necessary for the concerned authorities  to provide them with the utmost care and protection.The nobility of the profession struck me really hard and respect  for my fraternity grew multifold.

As I was suspended in the interim of life and death, the most striking realisation was that of kindness. How much love and kindness the world is filled with! People came forward to provide us with any support we needed, friends went out of the way to provide us with help in a very difficult lockdown situation, the hospital staff, right from the wardboys, mavshis, nursing staff, the canteen, the doctors took the responsibly of not only their respective tasks but went ahead beyond the call of their duty  to keep the morale of patient up so that they don't lose  hope.

How each every and every fibre of the fabric needs every other fibre to hold the fabric of humanity!

Gradually as blended with the surroundings, I started rooting myself in my one and half year long insight meditation practice. The mindfullnes practice teaches to witness everything eight in this moment, as it is, without judging. I started centering myself in the present moment, just witnessing what is happening niw. If i an breathless now, i am breathless. If ihace pain, i hace pain. If I am scared, I am scared. Nothing less, nothing more. Buddha's words used to ring in my heart 'In what is seen, there is just the seen. In what is heard, there is just the heard. In what is sensed, there is just the sensed. In what is thought, there is just the thought'. I held dearly to this 2500 years old wisdom. It's  nit that I was not scared, at times, fear did step in, but I was no longer scared of fear. Mind used to wander, chatter, think about untoward consequences but I used just witness those  and not draw any conslusions from that. I was being in the rawness of the present moment, not bothered about what arises in it. What arises, passes away.

It was a nightmare but it taught me more than a pleasant dream. It taught me about the kindness each one of us carries inside us, all the tilme, about  compassion, an innate human trait, an absolute contrary picture that we are made to believe in today's  times that world has lost love and kindness. 

Humans shall survive this pandemic greatly because of it's ability to reach out and help others with kindness and compassion, and that's  an absolute need of the hour.

It's  my humble appeal to each and every person to be responsible about one's own life as well as life of others, to stay safe themselves and help those who are in need.

It's in the worst of times that the best in humanity shines through the darkness and brightens up the world.

This pandemic may be the worst the world has seen in a century but I am also hopeful that this pandemic will see the best in the human species, the common singular foundation of which rests in kindness and compassion. And I am sure there would be many individuals like me all over the world who would have witnessed kindness in their own life right through all the uncertainty of sickenss, dying and death and would carry the light of kindness ahead to brighten up other's lives.

I write this as I await my discharge from the hospital in a day's time. I have been off oxygen mask since more than  a day now, without any discomfort or breathlessness. Sice three days cyclone Nisarga had changed the weather and from my window, I watched gushing winds, a downpour, grey skies. Today I look out the window, my only bridge to nature outside, and see bright warm sunlight hugging the trees, water-drenched leaves reflecting golden light, butterflies fluttering around merrily and a magpie robin singing. The cyclical nature of rain and sun, pain and pleasure reminded me of one thing, the joy of life.

Post-discharge

After coming back home and settling in the small comforts of home, I realised that I am not all well yet. I am able to do my daily tasks but breathing is still a bit laboured. I am continuing spirometry exercises. I have started my daily meditation  practice. I have started doing breathing exercises like pursed breathing exercise and abdominal breathing exercise. I am eating well, resting  well, sleeping well and taking the medicines prescribed by doctors. I am allowing my body to heal, keeping my mind calm. Now things  will take it's own course slowly. Our body has it's  own innate intelligence, what Alan Watts calls "innate intelligence of an organism". If we don't  meddle with it too much, and if we listen to our body and mind quietly and calmly, this 'intelligence' helps us at every step. 

Schooling in COVID- Summary of concerns

SCHOOLING DURING COVID PANDEMIC- CHALLENGES AND POSSIBLE MEASURES OF MITIGATION

A WRITE UP FOR THE STUDENTS OF THE STATE OF MAHARASHTRA STUDYING IN SCHOOLS OF THE STATE BOARD

                              

INTRODUCTION

Schools in Maharashtra have been closed since the second week of March 2020 due to the COVID Epidemic. This period was the least challenging as decision regarding impending exam was taken immediately and then schools took a break for vacations.

Several documents about maintaining safety from the CORONAVIRUS have been issued by various authorities. They can guide the measures for safety from virus. This write- up is exclusively about the issues related to child mental health- namely learning, development and prevention of mental illness.

STAKEHOLDERS AND POSSIBLE CONCERNS

1.      CHILDREN- Learning, Socialisation, co-curricular activities

2.      PARENTS- Safety, academic challenges, motivation for schooling, child minding

3.      TEACHERS- changed modes and teaching methods, job security, financial security, safety

4.      SCHOOL ADMINISTRATION- Safety of all, logistics of organizing, maintaining financial stability, ensuring compliance with regulations

5.      AUTHORITIES- ability to foresee and plan, be fair to all stakeholders, timely action

6.      MENTAL HEALTH PROFESSIONALS- prevention of mental health disorders, prevention of detrimental psychological reactions in all stakeholders but particularly in children, ensure adequate learning outcomes in children, maintain developmental trajectories in children, promote resilience and learning of coping skills

CHALLENGES

1.      Extreme heterogeneity of school settings- rural, semi urban and urban. And accompanying culture and priorities

2.      Wide disparities in facilities in schools- space, time, teaching aids

3.      Lack of examples that can be followed or at least used as a benchmark

4.      Children are low priority group and education is low priority sector and in context of pandemic and economic chaos- their importance has further gone down

APPROACH

1.      Children’s well- being must be the first priority

2.      All stakeholders should get a fair consideration. However, in case of conflict of interest, the child’s well being must be given precedence

3.      Guidelines should be timely and time bound. They need to be revised periodically to ensure gradual return to normal

4.      Feasibility should be considered

5.      All schooling methods should be considered

6.      Based on literature available about children’s health, development, learning and related areas

MITIGATION STRATEGIES

1.      Adjustment of syllabi

2.      Adjustment of pace of teaching

3.      Multiple modes of teaching- live online, recorded video, etc. should be flexible and contextual

4.      Consider greater contribution of parents and siblings including home schooling

5.      Modify role of schools as mentors and guides rather than only directly imparting education

6.      Include indicators of irregular school-work and learning problems

7.      Provide for assessments and remediation of learning problems

8.      Consider reasonable concessions for all stake holders

Do Doctors have fear?

The short answer is 'Yes, loads of it'.

Doctors are worried about the impact of the COVID epidemic on their family, health and finances. The call of duty seems such a burden now. It is fear that is making people avoid covid duty- the complaints of poor pay, poor facilities, unfair demands- these are all mere excuses.

Fear is definitely warranted too. The administration and society at large has been jealous of the imaginary privileges that doctors have- actually doctors have no privileges. They pay the same rates and taxes, and have to encounter the same struggles as in the average person's life. The deep resentment of the community towards doctors manifests as repeated persecutions in subtle and forceful ways. Thus doctors, too have lost trust.

Doctors want to know if they will get ppe, medical treatment and in event of demise - something of a support for their family. Many doctors are the only breadwinners of their families. So its very reasonable for them to be fearful. A simple answer to convince doctors to work is to offer them these facilities in writing- a proper letter of appointment mentioning all the things is needed. Anything less indicates an administration that is commitment- phobic and not trustworthy. How can you expect someone to put their life and the security of their family at risk for some flimsy verbal assurances?

The administration, particularly senior doctors in positions of authority need to understand the psychology of fear and address it because it is legitimate. Going for COVID duty without any sort of documentation based on which doctors can hope for even the basic care and compensation- I dont think other corona warriors are being expected to do so. I exhort the senior doctors to stop speaking threatening words of punitive action and instead initiate a dialogue to dispel fears of doctors. It should be done for every person in this situation- why not for doctors then?

We are confused and not at all serious about COVID

so I stepped out to get some essentials from the medical shop and I was relieved to find just one customer before me. Only one customer allowed in at a time and I could see what was happening from my place outside. Grandma had a 4 year old with her. And they were trying to choose a bag of chips. So each bag of chips was shown to the youngster who held it for a while and then returned it so she could see what was the next choice. The girl had a large, ill fitting mask hanging under her chin and Grandma also wearing something resembling a mask. After a good 20mins wait, I had to request them to hurry up and then after another 10mins of haggling over the price they were leaving. So I asked Grandma why she was outside with a small child and she showed me that the child had a rash that hadnt gone for about a week now despite the Doctor's advice. She was here to show the rash to the chemist. The Dr's note said 'Chickenpox' and sure enough the kid had a rash all over body that was typical of chicken pox. Grandma not convinced, pharmacist refused to treat the child and so Grandma proceeded to the next shop for advice.

Coming out I notice most folks roaming quite casually without masks. At a bread shop, the owner asks the customer 'where is your mask?'. Asks him to stand back to maintain social distancing. And as if the shopkeeper has abused him the man shouts a tirade at him about being insensitive to an old man who has merely been forgetful! Next I go to the lab for my blood test. Every new person has to be instructed by the staff to wear their mask properly and maintain social distancing. Most people wear their masks to cover only the lower lip. Its too hot when the mask covers the nose. And if it covers both lips, we cant talk. Some wear it like a scarf bunched around the neck and then pinch one end of it around the nose sometimes- how they decide when the nose and mouth are to be covered I could not find out.

Covid epidemic is real. And its spreading fast in Mumbai. Studies have shown that it can be controlled if everybody uses a mask- a fabric mask is sufficient. But the mask has to be worn by everyone, at all times when outside the house and the mask has to be closely fitting to cover the mouth and nose. How can this detail be conveyed to the public?

COVID- 19 and my experience

COVID-19 has affected people's mental health in different ways. Its not all bad. For example children are thrilled to bits that their parents are around. Except for people in troubled families, generally everybody is appreciating this time they are getting with each other. The need for diversion and entertainment has actually gone down with people really discovering that they love to just do things around the house or be with their family members.

However, I was much surprised that I saw a spurt in referrals for acute psychosis. It appears that people here have vulnerability to psychosis, as a population. Its also possible that the other folks reached Psychologists, while Acute Psychosis cant do without a Psychiatrist's medical intervention so I had to see them. Anyway- people developed delusions about having COVID- that then progressed into delusions of persecution that someone was trying to give them COVID purposely and so on.

Our Police and Chief Minister have constantly been worried about poor compliance to the lockdown orders. In my mind, this is a problem that needs to be researched and understood from a psychology perspective. The non cooperation is a feature of 'normal' individuals and needs to be understood from the perspective of culture and personality. Expert in fields of sociology, anthropology and social psychology need to be consulted on getting a plan to avoid overcrowding. It something urgently needed, because the triad of social distance, hygiene and personal protection will need to be followed for a long time to come.

I expect that this year schools will need to be online. I am not going to present the practical issues like lack of devices, etc as that is not the worry of a Psychiatrist per se. My problem is: As we are not allowed to prescribe stimulants after tele-consulting, learning challenges of children with ADHD may be magnified.  We Psychiatrists will really need to come out with coping strategies for families with children. A lot of their learning will have to be supervised by parents and parents need to be seriously empowered by modules on teaching along the lines of home- schooling. But home schooling isnt as rigid as a regular school curriculum is- and therefore parents are going to be struggling to cope with the speed. So schools also need to see if they can have a time table where longer parts in one subject are covered in a day and only 1-3 subjects done daily.

As we brace for a new lifestyle a lot of learning and unlearning will be needed and what do you think can help families and children?

WHY PERSONS WITH ADDICTIONS NEED MEDICAL HELP?

WHICH TYPE OF ADDICT NEEDS ACTIVE MEDICAL INTERVENTION

The definition of addictions has now been broadened to include a wide range of habits. This is in addition to habitual use of mind- altering substances. Some people are able to quit these addictions without absolutely any medical help. It is good if the withdrawals and recovery are uneventful. However, some persons will do better to seek medical help.

There are many reasons for getting medical help for addictions. One reason is that addictions are medical disorders diagnosed under ‘mental illness’ because the problem is mainly of behaviour. The problematic aspect is that the person begins to value the addictive habit more than anything else in his/ her life. Second reason is that the habit causes harmful bodily changes- for example liver disorders caused by alcohol. This will need to be checked by a doctor. Thirdly, some medicines are used to manage withdrawal symptoms and to reduce the temptation to use again.

As addiction is a behavioural disorder, Psychiatrists deal with it. Ideally all persons should go for a medical evaluation. Out of them some persons need hospitalisation. People using large amounts, continuously and suffering from many complications are admitted. Persons who have physical or mental illness or injuries, along with addiction also need hospitalisation. Some persons have tried to quit many times and have been unsuccessful- such persons need to be in rehabilitation centre for few months. Persons using multiple substances also require admission in a deaddiction facility. Rare and unusual addictions will require greater medical supervision, not necessarily hospitalisation. Persons with reasonable health, moderate levels of consumption and good motivation can be treated with minimal or no medication outside the hospital. 

TUITIONS FOR CHILDREN

When we were in school, it was a matter of shame to go to ‘tuition’. It meant that there was some weakness or intention to take a dis-honorable ‘short-cut’ in study. Nowadays, tuition/ class/ coaching has become part of almost every child’s routine. OK- Parents have become busier, more ambitious and have the money to buy help for their children. But often the child gains nothing from the tuition class. Why is it so?

It is found that child is admitted in tuition class for all the wrong reasons. 4 and 5 year olds are sent to tuition class because parents are unable to get them to sit in one place and study.  But in reality, it is not expected of children so young to be able to sit and ‘study’. Some children are sent to tutors because they trouble parents at home- so it is more like a child-minding exercise. In extreme cases child is rotated through multiple classes because there is no one available or willing to take care of the child at home. In these cases, often children are sent to self appointed teachers who are seldom qualified to teach. Some parents send children because others parents send; even children sometimes insist on going to tuition because their friends are going.

Poor academic performance is the only valid reason to send a child to tuitions. But this should be done only after thorough investigation for the cause of poor performance. One common cause of poor performance is poor teaching method- if restricted to few subjects, a qualified tutor may be employed. But if extends to several subjects, parents need to consider change of school. It will be overwhelming for the child to spend time relearning all subjects in tuition. Intellectual limitations, learning disorders, attention deficits and emotional problems also interfere with learning. Parents should seek counselling if any of these problems are found. This helps them to have realistic expectations from the child and to follow a plan which can help child to cope with studies properly by addressing the problem.

As it is, children are already burdened with school work. Parents should negotiate with the tutor not to give any homework. Some children only require assistance in completing their classwork and revision. Some children require teaching of concepts. Some children need practice. Yet others need only tips in presentation. A tutoring program cannot be ‘one size fits all’. Smart parents understand this and negotiate with the tutor to deliver tailor-made help.

Children attempting specific competitive exams or exams in subjects not available at school will also need tuitions. Because both the content and pattern of study are different and someone is needed to teach that.

It is the duty of parent to understand the process of teaching, decide whether it is suitable based on the child’s problem and monitor whether learning is happening. The child needs to be supervised to ensure attendance and attention. The tuition situation also needs to be safe- no child should be left alone with a tutor of any gender, age or even if you know the person well. Tutors should not be allowed to intimidate or abuse the child in any way. I have seen children who were threatened, pinched or beaten by tutors due to which they became emotionally disturbed and turned off from studies forever.

Most of all, the child should never be forced into tuitions. Child’s opinion and cooperation should be expressly sought. Tuitions should be few and meant only to help the child achieve specific learning goals.