By Alison Shamwana | Started 30th Apr 2020
INTRODUCTION BY MARTIN SMITH, IHPBA PRESIDENT
Follow this link to read the introduction by our President, Professor Martin Smith.
COVID-19 Video Diaries
Doctor P. Jagannath
Chief of Surgical Oncology at SL Raheja Hospital, Lilavati Hospital (Mumbai)
Close call followed by a long week...
We had started cancer surgeries despite 80% beds being earmarked for COVID. I strongly believed and wrote many times that non-Covid patients like Cancer patients are actually suffering due to lockdown. We had a set protocol of Covid test, HRCT thorax and then admit for surgery.
I had this sense of ‘invincible bravado’ that my family disapproved. But the sick had to be cared for, so it was surgeries with PPEs and protocols.
Two weeks ago we did a standard procedure on an elderly lady. On the third postop day in ICU, I found the lady coughing. By some instinct, I asked for a throat swab though she tested negative before surgery.
It was Saturday late evening and my registrar phoned frantically “Sir, she tested positive”. My heart sank. How many people were exposed? Surgeons, anesthetists, nurses, ward boys and ICU staff were all part of contacts. All of us were scheduled for throat swab on Monday. CEO phoned up advised all of us to ‘self quarantine’.
My resident and the ICU registrar tested positive. So there was spread.
Then it really hit me. How do I self quarantine? My 93 year old father stays with me and I need to take care of his needs on a daily basis. What about my family? Mind raced in multiple angles. What if the test is positive? Frantic search and calls for medication to be taken. Its no longer an academic search.
Rationality is pushed back. Science is any how confusing . I have been on HCQ like most of my colleagues.
Take another dose said my colleague. Done and what else?
Gargle with hot water, spirulina, Ivermectin. What else? Homeopathy? The suggestions are endless.
There is no downside risk, so take it. Quick order to the chemist for drugs. I did not tell my father. ‘The hospital has asked us to be careful’ was the line.
As luck would have it, the lab phones, saying that the particular batch of tests did not go well. Holy smokes, what now?
Don’t worry Sir, tomorrow we will run it again, say the lab.
What I am going to do tonight???
Then you start developing vague symptoms. Body is aching. Is there fever? No. How about SpO2. Fortunately there is pulse oxy at home. Reassured that the reading is fine.
Next day the Lab says test is negative. Partial relief. As we need to test again after 4 days. Too soon in the illness, RT PCR can be negative. Isolation continues.
So agonizing wait for the fourth day testing. Every morning and evening, taste the food and smell. Oh fine I can still smell and taste. In some that can be an early symptom.
Finally the second test also comes negative.
Such relief. I cannot describe the racing thoughts in the longest week of my life. Waiting anxiously, imaginary symptoms, scenarios that flash through. Looking for any information that can help.
I can well imagine what patients, family and the contacts go through.
Then it happened to a close friend and his family. They too went through the same anxiety, logistic nightmare and worry on the uncertain course. Relieved that all are well.
I no longer have the sense of ‘invincibility’.
We are fortunate to move along and be safe. Thank God for the same.
I will never push my luck and will be extra careful.
I can only tell you and ask you to be super careful. Then the panic can be avoided.
…. Tomorrow, the beginning of new day in a surgeon’s life
What next after the close call ??
As I said earlier, I had a close call but all tests turned out negative. Some well wishers and my family were naturally anxious. They asked me to go slow. “You are 60+ and worked for more than three decades, why don’t you go easy now?” It is a sound advice but I’ll tell you a couple of real life stories which shaped my decision. I am using real names because they are real heroes.
Dr. Prabhu Desai is our popular Chest Physician. When COVID patients started pouring in, they all need the services of a chest physician. There are so many people scared of donning the PPE suit. Dr. Prabhu Desai literally had to go in sometimes six times with PPEs to see patients and plan the treatment.
Many of the chest physicians, nurses and residents were exposed and turned COVID +ve. One day I was distressed to learn that Dr. Prabhu Desai is admitted to the hospital. I messaged him and in his remarkable positive way he said, “No problem, I am fine. I felt I should just get into the hospital for safety. Even now I am treating patients remotely in the COVID ward.
“Can you also help a good friend of mine from Hyderabad?”
He said “Sure, let me talk to him”.
This is the spirit of a dedicated professional. He was always positive even on Remdesivir and in a week’s time he was discharged, only to continue to help patients from all over.
The same is the story with our Infectious Diseases Specialist, ICU In-charge, Cardiologists, many residents and nurses. These are the people who not only had COVID, came out of it and were willing to get back to the hospital to help more patients. Even my resident Dr.Webster beat Covid 19 and appendicitis to be back on duty in “Covid ward”.
Then there is Sr. Mary. We were happy to welcome her back to the OR after 2 week battle with COVID. I was getting ready for surgery I said, “Sister, why don’t you take rest?” She said “No, I am absolutely fine, I will wash up for surgery”.
Then she quietly comes up to me and says, “Sir, I have antibodies +ve. If anybody needs plasma I am ready to give as a plasma donor.” I was amazed.
Yes, some of the doctors are staying back home, maybe there are some co-morbid conditions and it is advisable for them to stay back but those who are otherwise fit, there is no reason to shy away.
I love my work.
I am passionate about surgery,
I want to take care of patients.
It gives me a sense of purpose in my life.
I cannot trade it for any kind of retirement, at this point, as long as I am physically fit.
I had promised my family that I will go slow, that I would not operate for a month. But soon I had to break my promise. I couldn’t say ‘no’ to a young man who drove all the way from Agra for 2 days for a surgery only by me, nor could I refuse a patient of jaundice who needed urgent surgery- complex Whipple's and came in specifically for my help.
Yes, we will take precautions, we will do everything possible to safeguard ourselves and the our family and our hospitals.
So here I am back at work, ready to do what I always cherish, “Surgery for cancer patients”.
Michelle L de Oliveira - President of the UEMS HPB Board of Examination:
Follow this link to read an explanation by Michelle L de Oliveria, President of the UEMS HPB Board of Examination) on the impact of the COVID-19 crisis on the late 2020 examinations, the wider impacts to the HPB surgical education system, and how the HPB syllabus may need to change in response.
Orlando Torres: Being an HPB surgeon during the COVID-19 era.
Follow this link to read Dr Orlando Torres’ account of how COVID-19 impacted not only his professional, but also personal life.
AHBPA Webinar on COVID-19
Follow this link to view the AHPBA Webinar on COVID-19 and HPB Surgery. This is a very useful discussion, but please note that it took place on 17 April so data provided in the webinar and the Q&A should be viewed in light of a rapidly changing landscape.
Impact of the coronavirus pandemic on the role of HPB surgeons in Tongji Hospital, Wuhan, China
This report [link] by Lin Chen, Zhi-yong Huang and Xiao-ping Chen describes how HPB surgeons in the Tongji Hospital of Wuhan, at the epicentre of the coronavirus outbreak in China, were called upon to assist in the fight against coronavirus, and the strategies adopted to successfully deliver HPB service to the most severely affected COVID-19 patients and others during the last four months.
Being an HBP Surgeon during COVID19 times
Follow this link to read a report by Fabio Ausania, Hospital Clínic de Barcelona, on the impact COVID-19 has had in Catalonia.
Delivery of HPB surgery during the COVID-19 pandemic: an European-African HPB Association Survey
Watch this presentation by Anita Balakrishnan of the results of the above survey to which many of you will have contributed:
A paper is also being published in HPB, you can view the full text here
Please use the discussion board below if you have any questions for the authors on the survey or results.
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