Covid-19: Reflections of an Anaesthesiologist

Article by Dr. Sharath Krishnaswami

Everything can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.” – Victor Frankl1

I sit at a 4 by 4 feet room. The hum of the air condition rings by the side of my ears. The familiar sounds of the garbage truck taking it’s load for the day and the chatter of patients by the side of the building is missing as I bite into my sandwich. The 20 minutes that I have for myself for lunch in a 12 hour shift. And I think to myself. Why?

Why must we persist when the world has crawled back into its shells. Covered down into its caves and peeping to see light only to scurry back again and hide in fear of this unseen enemy. Why must us anaesthesia residents heave and struggle to breathe through 2 masks, hoping oxygen will pull through all those layers just so we can push through another long shift. Why must our fingers struggle to catch sight of the vein wearing 3 gloves and peering through our foggy glasses and transparent screens through our hoods?

covid ppe

Victor Borge, the Danish Comedian, Conductor and Pianist 2 said that the shortest distance between two people is a smile. But when the smile is covered by an N95 mask, all we are left with are our eyes to convey our initial impressions. Glancing at strangers in the subway. Walking past people who have their alms out asking for money because their jobs have been consumed by covid and the unrelenting industry. Eyes of an eager intern hoping to give their sweat and tears to their first ICU posting and the tired scared eyes of an Anaesthesia professor who knows he’s more vulnerable to the Virus.

And yet, the intern must work if the patient is to be saved. And yet, the Professor must teach if the Resident must know how to care better to failing patient. And yet, the patient must lie on the bed, tubes running in and out of him, drugs being infused into his veins and radiographs being taken at frequent intervals just to know what designs the infinitesimally small has on a human’s lungs.

When the Black Death swept across Europe between 1348 AD and 1350 AD, it killed 30% of the popular. 25 million people succumbed to the infection worldwide3. And yet, this was a time when the microscope hadn’t been invented. And sudden deaths were ascribed by religious sects as the plague being a punishment from God for humanity’s sins. Certain other religions believed that the plague was a merciful gift from God which provided martyrdom for the faithful whose souls were instantly transported to paradise4. All because they couldn’t identify the source of the infection. A 0.8-2 micrometer sized bacteria5. And yet, what we face now is a 60-140 nanometer sized virus6; 1000 times smaller than the aforementioned bacterium that humbled Europe.

In 700 years, how different are we from facing such an onslaught. Anti-Mask Protests in America and Australia believe that the simple act of wearing a mask is an attack on personal freedom.7,8 Where does freedom end and the path to self sustainence begin? In a world where hospitals turn away covid patients in the fear that the hospital may succumb to negative publicity, spread of the covid-19 and the collapse of its infrastructure, what value does one place on profit in the face of economic outage?

And yet, America, the world leader in Science and Technology9 flounders at the earnestness at which the virus penetrates the foundations of the state. Can the homeless man on the street, moving from building to building seeking work and a morsel of food be treated for an infection for free? When a single cough from him can infiltrate the air10 and land on the millionaire that rides his Harley Davidson, rendering him invalid and dependent on life support for weeks? How are we treating our most disadvantaged? How is the covid infected daily wage worker at fault due to unscreened passengers flying fashionable jets across countries? Is this a warning sign for us to change our healthcare systems around the world? Do our economic policies put health and the containment of pandemics as first priority as compared to putting crony capitalists first?

While the world moves with bailing companies and realizing that the human workforce is the strength of the organization, it has finally occurred to them the importance of the ‘Anaesthesiologist’. The healthcare worker called by almost everyone during times of trouble and when a patient sinks at any corner of the hospital. The medical professional who infuses oxygen into a breathless patient and coaxes a failing heart to start amongst other things.

And yet what is the world to the Anesthesiologist?

We are infused with life and death at close hand. Depression and anxiety crawls under our skin as we maintain a stoic stance in the face of gloom.11 We are nether creatures barely identified by humanity. We are professionals unseen by the common eye.

Our lives count.

Our lives must count and we must invaginate ourselves as the inevitable forces that make humankind push through pandemics, typhoons, earthquakes, economic downfalls and man-made disasters.

Our lives count and we must live every minute like it’s our last. Tell our partners what they mean to us, be thankful to our families that have understood our vigorous regimes and tell our enemies that enmity has no point in front of a virus that can make you fall flat on the floor and extinguish all that you are.

When Victor Frankl, the Austrian Neurologist and Psychiatrist12 who survived the Holocaust,  wrote the above lines in his book ‘Man’s Search for Meaning’, he didn’t realize he was inspiring generations of medical and non-medical personnel who faced death at close quarters. His philosophy of “Healing through meaning” is a lesson that some of us must allude to our demanding lives. Because when we are faced with trying times and imminent death, all we have is our attitude towards it.

References:

  1. Frankl, Viktor E. (Viktor Emil), 1905-1997. Man’s Search for Meaning; an Introduction to Logotherapy. Boston :Beacon Press, 1962.
  2. Black Death. (2020). Retrieved 27 November 2020, from https://www.history.com/topics/middle-ages/black-death
  3.  Victor Borge. (2001, November 7). Wikipedia, the free encyclopedia. Retrieved November 28, 2020, from https://en.wikipedia.org/wiki/Victor_Borge
  4. Mark, J. (2020, November 24). Religious Responses to the Black Death. Retrieved November 27, 2020, from https://www.ancient.eu/article/1541/religious-responses-to-the-black-death/
  5. Yersinia pestis agent information sheet | Research support. (n.d.). Boston University. https://www.bu.edu/researchsupport/safety/rohp/agent-information-sheets/yersinia-pestis-agent-information-sheet/
  6. COVID-19: A new challenge for human beings. (n.d.). Cellular & Molecular Immunology. https://www.nature.com/articles/s41423-020-0407-x
  7. Forbes. https://www.forbes.com/sites/tommybeer/2020/07/16/anti-mask-rallies-continue-in-us-amid-rising-coronavirus-cases-and-deaths/?sh=753501c52246
  8. Melbourne anti-lockdown protests: At least 15 arrested in violent clashes with police. (2020, September 5). the Guardian. https://www.theguardian.com/australia-news/2020/sep/05/melbourne-anti-lockdown-protests-dozens-arrested-in-violent-clashes-with-police.
  9. America leading the world in science and technology. (2019, April 23). The White House. https://www.whitehouse.gov/articles/america-leading-world-science-technology/
  10. Coronavirus disease (COVID-19): How is it transmitted? (n.d.). WHO | World Health Organization. https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted
  11. Work-related mental and behaviour disorders in anesthesiologists. (n.d.). ScienceDirect.com | Science, health and medical journals, full text articles and books. https://www.sciencedirect.com/science/article/pii/S0104001414000165
  12. Viktor Frankl. (n.d.). Encyclopedia Britannica. https://www.britannica.com/biography/Viktor-Frankl

Author:

Dr. Sharath Krishnaswami is a practicing anaesthesiologist from India. He is presently pursuing his residency in Neuroanaesthesia. His interests include poetry, theater and off beat cinema.

E-Mail Id: [email protected]

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