Physicians’ Untold Stories #1

“There are only two sorts of doctors: those who practice with their brains, and those who practice with their tongues.”—William Osler

I am happy to introduce our guest writer this week, Dr Syed Faisal Taha. He was my clinical specialist when I was working as a medical officer in Seberang Jaya Hospital.

He is currently a consultant nephrologist and physician in Kedah Medical centre. He is an excellent storyteller and recently via his Facebook shared his scary moments behind the Sungai cluster outbreak in his hospital.

Let me present to you Dr. Syed Faisal Taha’s untold story- A New Norm in A Dialysis Unit.

A New Norm in A Dialysis Unit

What would you say if I were to take you for a tour of my dialysis unit? What more,you don’t have to pay for the booking fees, in fact, you don’t even have to pay a dime for it.
It’s on the house. Hmm, I can see that sparkle in your eyes, but don’t pack your suitcases yet. We are going on a special trip that requires some imagination and virtual engagement. There’s no better time to do this than now because I only offer this tour during the pandemic.

As you know this kind of pandemic may happen only once in our lifetime. Provided it doesn’t shorten it…..opps! sorry a bad joke.

On this tour, you can wear whatever you want or don’t want …only on one condition. You must imagine you have got to put on your mask and face shield throughout. I suggest you wear our plastic apron and disposable gloves too. You see over here, we are not just worried about Covid-19. We have got other worries on our shoulders too like needle prick injuries, splashing of the dialysate fluids that may carry other viruses like hepatitis B and the likes. Some patients may carry nasty bacteria like MRSA that you may not want to bring it home.

Alright, so much for the preliminary friendly introduction, looks like we have already arrived at the entrance of my unit.

Shhh!…can you sense how eerily quiet it is over here. Usually, there will be a throng of people at this waiting lounge. Loyal wives waiting for their husbands, mothers always at the ready to attend to the needs of their children while undergoing dialysis, and kind-hearted children who may want to serve some food to their sick mothers. Unfortunately, because we have to observe a strict social distancing framework now, they have been banned from waiting. Now their loved ones need to fend for themselves for the family support.

Otherwise, you may also be able to observe how popular I am over here. Let me tell you how you will be feted like a star when you arrive. These family members will never fail to offer you their share of food, just like any typical friendly gesture of a Kedahan who cares whether you have eaten or not. Name any, Nasi lemak, Teh Tarik, Rojak cicah, the list can really go on. Hopefully no Durian, please. I really miss this atmosphere of a fiesta, no wonder I am losing a bit of weight now, and feeling much lonelier. I can imagine this feeling can be worse for my dialysis patients.

“There you are Dr. Syed”,…..This is the daily welcoming remark I will receive from my head of the unit, Unit Manager (UM) Zaleha, every time you enter the door. I know it can sound a little bit intimidating at times but she is built-in with a no-nonsense character. In fact, she is the right person to helm the management of the unit.

She is the kind of a person that reminds me of my pet tortoise, if it bites you it will never simply let it go. Well, I don’t blame her because this trying period requires a heightened sense of suspicion and alertness. If God forbid, if there is an outbreak in the unit, they will go after her first. I’ll probably be next.

Of course, you will also be welcomed by a beautiful selection of my dialysis nurses who always bear dreamy smiles at you except now you can’t appreciate it much. They are always hidden underneath their face masks and face shields twenty-four seven. They are always delighted to meet a special guest like you but they may not be able to throw a friendly chat because we have to keep ourselves 1 metre apart at all times. We used to congregate at the nursing counter where we usually layout plans and exchange social remarks. Now it is a memory of the past.

If you really wish to get to know my group of nurses today, you better do it now. This is because there will be a different set of nurses in the team tomorrow. You see, during this pandemic, we have to segregate our nurses strictly into their own shift. The way how the dialysis treatment goes is a patient will undergo three times per week of a session.

So they will come either on day 1,3, 5 shift or day 2, 4, 6 shift. So there are 2 teams of nurses to manage each group and they are not allowed to mix with each other. The science behind this is that if there is an outbreak, not all nurses will be exposed and we don’t have to shut down completely. You have to know we do not operate like the operation theatre here. They have elective cases that can be canceled, but for our dialysis patients, every session is never elective, it’s compulsory.

I am sure you can recall when we had our slice of a scary experience during the Sungai Cluster outbreak recently. Everybody else at the hospital was given a reprieve, we shut down and allowed everyone to stay at home. It was a sense of relief that they were allowed to be taken away from the epicentre. However, the business was as usual for all of us here at the dialysis unit, nurses, and patients. If we were to follow the pace of everyone else and came back after two weeks of closure, I doubt we can have any of our patients back, you know what I mean. In fact, because they needed to continue their dialysis sessions during the outbreak, we had to subject them to the compulsory PCR testing at our backyard. Some had to be wheeled because they were too frail to walk.

Let me show you the legs of my nurses. Now, now don’t get me wrong here. I am just going to show you the sores they bear from prolonged standing after attending to the patients. Because they can’t mix with the other group of dialysis nurses, they have to deliver their service throughout the day without any respite. Each day we have 3 shifts of patients. Each shift consists of about 16 patients. Each shift lasts for 4 hours not counting the interval of changing the shifts. Basically, they are moving about from 6 am up till 9 pm. In fact, this is not just a matter of moving about. They have to be utterly focussed at all times as they are always engaging in pricking the fistula or the dialysis access of the patients. Ah by the way don’t forget at the back of their mind, they must remember, social distancing, wear the PPE properly throughout….Covid-19 is still out there.

Speaking of social distancing, I am sorry I can’t bring you to our pantry. We used to have a little pantry at the back of our unit. It’s very decent with a microwave that you can heat up your food or make a cup of coffee. This will be the place where my nurses can take a break and chit chat after a stressful day. Unfortunately, because our pantry is so small only one nurse can be allowed to go in a staggered manner. Of course, you need to take off your mask when you go for a drink and you wouldn’t want anyone else to be there without your mask. I am sorry if you still can’t mingle or see the whole face of my nurses. Staff nurse Zaleha will report us to the matron if she finds us in close confinement like this, not for a social reason but for a procedural reason.

I hope you can also appreciate that it is not a cakewalk here. It’s not like as if our patients are here for a spa or a sauna treatment. We always pray that we will never encounter any emergency events here because even without it, it is already very tiring. Of course, this is a wishful thinking.

Please stand behind me!! I have to attend to this patient who has crashed in his blood pressure. During a dialysis session it is not uncommon for patients to suddenly become adrift and drowsy due to over-extraction of fluids or some cardiac conditions. Don’t just stand there, get me the resuscitation trolley. We need to instill the fluids. Get me the cardiac monitor and pulse oximeter. The patient can also be hypoglycaemic. Please give me IV d50% 2 ampules stat. Why is the saturation low? Could it be pneumonia? Wait look! Another patient at the end of the corner who seems to have some shivering there. Is he having a fever? Hope it’s not Covid-19 but he is having a catheter as his dialysis access. It could possibly be he is having a catheter-related infection. You see, we need to have an art
of a clinical practice here to differentiate between Covid -19 or not because we can’t panic all the time and jump to conclusions. Nevertheless, I hope you can appreciate the kind of drama we are facing here while a lot of the others are working at home.

“Dr. Syed, there are 2 of our patients at the waiting lounge who seem to be coughing but they don’t have any fever,” UM Zaleha has to interrupt me again.

“Can you tell whether these patients have Covid-19 or not now that even asymptomatic patients can also be positive?” I ask her again? If we allow the patients in and they have the virus, they will spread like wildfire as they are in close confinement anyhow in the dialysis unit. We designed our dialysis unit way before not knowingly that Covid-19 is going to add up a spice in our life like now. What more, these are the most vulnerable group of the lot and we can’t afford to make any mistakes. If we don’t let them in, they are going to be drowned in their own fluids. We can’t afford collateral damages too.

“Send them down to our Covid testing cubicle and get the antigen result stat” We can’t wait for the gold standard PCR as it takes 2 days to be ready. At least with the antigen test, we will know the result within 1 hour. Even if the result is negative, they will still need to be isolated in our single room because one can never be sure that an antigen that is negative is a true negative…you see how dire it is now.

The problem is we do not have enough isolation rooms here. To get the patient who is the most symptomatic with fluid overload into the room first and the other better one can wait elsewhere in isolation. By the way my nurse has to attend to this patient alone in a more stringent PPE as we can’t take chances to allow her to move about attending to other patients. As it is, the number of our nurses is already limited, so the others need to take over and make do.

How time flies…looks like we are already at the end of the first shift. The other new shift of patients are already waiting outside. It’s another commotion now as the nurses have to conclude the session. They have to press the fistula to avoid bleeding and it must be done quickly as we do not want the other shift to wait too long. Wait! I saw a patient going back the wrong way, let me stop her first. “Aunty, how many times must I tell you, you come in this way and come out a different way because we don’t want to mingle with the other shift, do we? Not till this pandemic is over ok?” Sadly the patient has to just nod because most likely she may forget again the next session.

Shall we wrap it up with our short tour? I hope you have been given a glimpse of our daily life at my dialysis unit. What have we learned today?

Not everyone no matter how scared they are with this Covid-19 can have the privilege to just stay at home or work from home. Definitely not for my dialysis patients, if given the option, they should be the ones who must really be at home as they are the most vulnerable. I hope you can also appreciate the level of the sacrifice the health care workers are putting into this. Day in and day out we are always exposed.

So the least that you can do is please wear your mask, protect us from the spread of the virus.

Hope you can find your way out. Don’t leave your belongings behind and take care of your kidneys. Hope I don’t have to see you again here.

-The End-

* If you have interesting stories that you would like to share with my blog’s readers, please email me at info@drgohhk.com