Syed Mudasir Qadri hasn’t had a good night’s sleep since March 2020. The scenes from his workplace, SKIMS hospital in Srinagar, during the first and second covid-19 waves—the full wards, the worried faces, the wailing—keep playing out in his mind. Memories of two very personal losses during the first wave come to mind, especially at night.
“They say time is the best healer. I think time is the best dealer; it teaches you how to deal with pain,” says Dr Qadri, an associate professor in the department of internal and pulmonary medicine at the government hospital. He says he’s no longer the person he was 17 months ago. He smiles less.
“We are doctors, we are trained to deal with difficult situations. It’s our job to save everyone who comes to us. But here we had to choose which patient to admit and which one to turn away (owing to lack of hospital beds),” he says. “I am better prepared as a clinician to face the third wave as I have more information and knowledge (about the virus), but inside I am completely broken.” Jammu and Kashmir saw a peak of over 1,800 cases a day last year, a number that almost doubled by March 2021.
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Dr Qadri is not the only one to have reached the end of his tether. Over the past 17 months, healthcare workers have become used to the physical toll of working long shifts in sweaty PPEs and boosting the morale of patients and families. Most are proud to serve but the surge in cases and deaths during the second wave has taken its toll on them too. Surveys around the world have shown that healthcare professionals are suffering from high levels of anxiety, trauma and burnout. A September study, published in Frontiers In Psychology, for instance, concluded that healthcare and emergency workers in Italy, among the worst-affected countries, experienced high stressors during the first wave of covid-19, exposing them to the risk of developing secondary trauma, or trauma incurred through people who have been exposed to trauma themselves. Some have sought therapy, others are suffering silently, believing that asking for help would indicate weakness and affect their career prospects.
While the authorities everywhere are equipping hospitals, securing oxygen supplies and bolstering facilities for the third wave, little attention is being paid to the parallel pandemic in mental health.
At the height of the second wave, India was reporting more than 300,000 cases a day. This has fallen to around 40,000 a day, with Maharashtra and Kerala reporting a bulk of the cases. But we aren’t out of the woods yet. Only 8.5% of the population has been fully vaccinated. The Delta variant, responsible for the catastrophe this year, is spreading. The medical workers are exhausted.
During a conference last week, Randeep Guleria, director of Delhi’s All India Institute of Medical Sciences (Aiims), suggested the third wave may not be as bad as the second one if people follow covid-appropriate behaviour. That’s a big if...
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While there haven’t been any national surveys on how healthcare workers are faring mentally and emotionally, our interviews with a section of doctors, psychiatrists and nurses suggest most are worried. The slow vaccination rate is leaving them apprehensive and seeing people return to pre-pandemic life, abandoning all caution, is only deepening their sense of hopelessness and fatigue.
Of the 30-40 calls Sasha Raikhy, a Delhi-based senior consultant psychiatrist with the Meddo healthcare platform, receives daily from people seeking help for rising anxiety and helplessness, at least one is a doctor. “It has never happened before in my 10-year career,” she says, referring to the number of doctors reaching out for help. “Doctors don’t generally share their anxiety or worries because they think it will show them as weak and affect their career. The truth is there’s a lot of PTSD (post-traumatic stress disorder).”
She often hears her doctor-patients discuss guilt. One struggled to sleep because he couldn’t stop seeing the face of a patient who had succumbed suddenly to covid-19. “He kept saying: ‘She was healthy and recovering well. I saw her eat breakfast and by lunchtime, she was gone.’” This helplessness at being unable to save everyone, when you have been trained to do so, can make you internalise guilt, says Dr Raikhy.
“Another doctor felt guilty about the death of his parents in a remote village because they couldn’t get treatment for covid-19 in time,” she says. “He couldn’t stop blaming himself for not being there; he had been treating covid patients in the emergency ward in a city.” He is not alone. Even those who are not in the medical profession have consulted her for the guilt they feel at not being there “when a close one was gasping for breath”.
Listening to the experiences of patients has taken a toll on Dr Raikhy’s own mental health too. She uses the same three words as some of her patients to describe her feelings: anxiety, helplessness and exhaustion. She has found comfort in meditating thrice a day and doing yoga. “It will take us years to overcome this kind of trauma, doctors or not.”
‘We have all changed’
Sarita Ahluwalia, the nursing superintendent at Delhi’s Sri Balaji Action Medical Institute, likens the past 17 months to the 10 days of Operation Blue Star in 1984. Just 24 then, and posted at an army hospital in Jalandhar, Punjab, she dealt with at least 350 of those injured during the first 10 days of that June, when the army was trying to get militant Sikh preacher Jarnail S. Bhindranwale and his armed supporters out of the Harmandir Sahib complex in Amritsar. “It (covid-19) has been like living through a war that refuses to end. We are no longer the same people we were before,” she says.
She has often felt on the verge of breakdown, she says, but has pulled herself together and gone on. The hardest day, she recalls, was when her father- and mother-in-law died of covid-19 and she couldn’t see them. “Things often got overwhelming…but I had to be strong for my staff. As a leader, I can’t show weakness,” says Ahluwalia, pausing to compose herself.
Almost every day, she had to counsel her 450-member staff not to be afraid to come to work. “While I was trying to convince them that everything is going to be okay, I was telling myself the same. It became my coping mechanism,” she says.
Like her, Jijimol James, the chief nursing officer at Fortis Escorts Hospital in Jaipur, is also training her staff in the basics of paediatric care. She says they are equipped for the third wave but is unsure about how they will cope with the emotional pain.
“When I became a nurse, I took a pledge to look after my patients. I will do that till my last breath but the thought of that experience—people begging for beds, for oxygen, for blood, for life—that’s just too much to bear. I pray to God every day it doesn’t come to that again,” she says.
Kabita Dhamni, a supervisor (facility management) at Delhi’s Safdarjung Hospital, who is an employee of SIS, shares that fervent hope. Throughout the pandemic, her family kept insisting she leave her job, but she remained resolute. “I am fully vaccinated but the fear of contracting the virus remains. Sometimes I wake up at night and cry out of fear,” says Dhamni, a mother of one, who has been working at the hospital since 2018. “But I have to work. My husband has not had a job during the pandemic. Further, it’s my responsibility as a healthcare worker to show up every day.”
Ajay Agarwal, the director and head of internal medicine at Fortis Hospital in Noida, Uttar Pradesh, knows all about responsibility. During the second wave, he realised there was no joy in his work any more. “We had to choose between two patients, whom to admit and whom to refuse. That’s the worst possible situation to be in as a doctor. It can haunt you for the rest of your life, and we had to do this a lot,” says Dr Agarwal.
He didn’t seek counselling, though. His strategy was “clinical detachment”, providing objective, detached medical care to maintain a distance from the tragedy that was playing out. “But at the end of it, we had seen so much loss, it wasn’t possible to remain detached.”
Swapnil Mehta says he’s prepared to fight the third wave, physically, mentally and emotionally. The pulmonologist, critical care medicine and sleeping disorders specialist at Mumbai’s Dr LH Hiranandani Hospital used to see 30-40 patients in just four hours when covid-19 was at its peak. At present, he’s seeing five-six. “Covid has given us a new kind of anxiety but we also need to remember that people are getting vaccinated. So the symptoms will be mild,” he says, adding that meditation and exercise help him to stay positive.
Talking to others helps as well, insists Dr Raikhy. “Whether you are a healthcare worker or not, you need to share thoughts with those you trust. We need to talk about mental health more; the government needs to do more,” she says. “We need to talk to get over this collective pain.”
Dr Qadri, meanwhile, has discovered newfound comfort in his work. “You lose a part of yourself each time you lose a patient. And you gain a part of yourself when a patient recovers and walks out of the door. That’s what is keeping me going.”
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