|LETTER TO EDITOR
|Ahead of print publication
Avinash Jain1, Sapan C Pandya2
1 Division of Clinical Immunology and Rheumatology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
2 Department of Clinical Immunology and Rheumatology, Sardar Vallabhbhai Patel Institute of Medical Sciences and Research, Ahmedabad, Gujarat, India
|Date of Submission||21-May-2020|
|Date of Acceptance||31-Jul-2020|
Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
It is a painful situation for everyone including those involved in direct care, those involved indirectly, and those not involved at all. Human behavior is half reflex, half volition, and out of those, fear is the most difficult to classify – here it is on the surface! Proximity, normally a welcome gesture to humans, is a terrifying concept these days. This might be good for the pandemic, in a way but with our profession, it distances the patient from us, something we are simply not used to, either side.
Out Patient Department (OPD) scenario – Enter Patient One – He/She sits at a six-feet distance and the managing health professional (HP) wants to quickly decide and redirect him/her to his or her home with/without quarantine and an undertaking, or a jail, oh I mean, a ward. In the ensuing haste, the HP forgets to counsel him/her and calm him/her not realizing how stressful it must be for the patient! Wait! Why did I use the term patient? I don't know yet whether he or she is a patient. Some of them are forced to come, some come on their own with just worry as a symptom, and some come with symptoms and the fear of infecting their loved ones. Let us assume, henceforth, the patient to be a male (for ease of writing and understanding). I have not even bothered asking him a detailed history as I want to finish this off quickly! I know those eight or nine symptoms now listed with varying percentages in COVID literature by heart! I am as qualified as a common man who also knows as much. Empathy becomes abstract where fear, indifference, and doubt reign.
After a few questions and answers, the patient is kicked out, his questions about his own life and death remaining to himself. What if he is a diabetic and has not taken any of his medications? He might wonder for the first time in his hospital visits, no one is bothered about the fasting blood sugar/postprandial blood sugar/random blood sugar charting! This is just the beginning of his tedious journey. He now goes to a pathologist who has to bleed him and a microbiologist or ear, nose, and throat surgeon for a swab! He is an unwelcome guest! He still waits for a word or two that would calm him. Probably the only thing that is touching and going through him are the radiations for the chest X-ray-the radiological “hug” or rather the radiation hug. It's a pity, man has to resort to machines for feelings and gestures which should inherently be classified as human! All this while his brain is preoccupied. He is pressuring his amygdala, no probably the hippocampus for recent memory output. He is scared like hell and ponders how much socially distanced he was in the last two weeks or so, especially from his loved ones! He is worried about them. He has decided to come alone because he wants no one else to be even a mile close to the hospital. He is ready to die alone if that maybe. He hopes for a negative report that would bring some tranquillity to his restless soul and in his own mind probably pledges of discipline, nicety, and no wrongdoing if God were to render him one more chance!
He is directed from a distance by the guard who holds a stick in his hand. The stick had never been so worthy to date. He feels safe with a stick in his hand-“chemoprophylaxis.” He enters the ward with HPs in their astronaut attire. The face is masked. Emotional exchange in times of rigorous protocol pursuit is forbidden. There is just one way “visible” exchange of expression. We don't know what is happening behind the mask. We might be genuinely concerned and look after them and give a helping hand and tell them all will be fine. But, we have become untouchables. The cerebral love, oh I mean cerebral lobe is watching the clock, rehearsing the protocols to be followed once we reach OUR homes or OUR quarantined lives, to OUR loved ones, or our consciences, respectively. The overriding thought in mind is how not to carry anything home. Who is at fault? They probably receive the same treatment. A father cannot sit with arms around his son or daughter, cannot feel the movement of his unborn baby, or hug his wife. The same goes for a HP who might be a daughter or wife or mother. We all are untouchables from now on! In a way, we are paying for the casteist divide we practiced in the past, or in rural India, even now! Humans would do that to other castes and now nature is doing that to us.
Patients in the wards are afraid as they await their reports. They are not making any new friends. No one wants to be “positive;” be it reports or conduct. Word positive throws a chill down the spine. Some of them are mischievous and this affects everyone. Word sensitivity has gone for a tumble. Only sensitivity that is known now is expressed in percentage. Sympathy has substituted empathy. Care without touch and empathy is no care. Is it the need of the hour? Maybe yes. But, it is not contagious to utter words of love and affection behind the N95 mask or “pseudomask” for some even if eyes can't express. Even patients do not want to talk to each other; afraid the virus in others' may be more dangerous or more contagious. No one but the media and WhatsApp are teaching them. It is a MESS. Mass Education with Suffering and Stress. “Let us not be afraid. If we are sincere and maintain discipline we all can fight and emerge victorious.” We say more out of zeal than faith.
But, everything is not as negative or dim. Fear might have crept in but people are sacrificing their lives, be it a HP or an individual. They are living in quarantine away from their loved ones so that they do no infect. This is a “self-immolation.” A mother wants to stay with her child or a son, daughter wants to stay with her father/mother or vice versa even if they are positive; “COVID positive.” Human bonding has brought them closer to each other. They do not want to leave them alone. They understand each other's worthiness. They have now learned to respect their colleagues or workers or “maids.” Corona times may be bringing out the best in some and worst in others. The world is trying to balance itself. Research is being pumped in to bring out a vaccine as quickly as possible. But, in the meantime, people are learning to live with each other and understand that nothing should be taken for granted. They are getting emotionally vaccinated and hope the memory “T (thoughtfulness)” cells last forever. Everyone is sacrificing in some form. The sacrifice of not being able to care with empathy and sacrifice of being labeled an untouchable. But, we have to find a midway. Togetherness with mindedness.
It is rightly said, testing times forge character. It has. We Indians are emotional people. Ending life for another is the greatest virtue – our Epics say. And so, we will not turn around, we will not give up. As thoughts of our families, our friends, our seniors, juniors, our milkman, our office receptionist cross our minds, for we are, but humans, bed number eight hemoptyses suddenly and collapses and there we are, all draped in blood, forcing the intubation into the patient's respiration for the latter to carry on!
Suddenly, untouchability does not seem to matter….
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.