15 July 2020
Medical intern Danielle Moulton takes just three things into the hospital with her in the morning: her car key, a pen, and her phone in a plastic zipper bag. The rest of her belongings stay in the car, as her day in the Covid-19 wards of Groote Schuur Hospital in Cape Town starts.
At work she has a quick cup of coffee and a big gulp of water, knowing that she won’t be getting a break for a while. At the entry to the ward she starts in the clean room, donning her Personal Protective Equipment (PPE). “This is a war that we’re fighting. It sounds super lame, but you’re almost putting on your armour for your battle.”
A full set of PPE includes a hair net, booties, gown, a visor, and an N95 mask “which you end up checking a million times during the day”. This is worn over her medical scrubs. She wears her “corona shoes”, an old pair that she “is not going to miss at the end of this.”
The whole process takes a while. At the beginning of their stints in the Covid-19 wards, the interns used a buddy system to don and doff the equipment. They watched each other to make sure the others were doing it right until they got used to the procedure. “You become so hyper-vigilant, you’re anxious that you’re doing something wrong or that you’re forgetting something.”
Moulton says the visor is the most constricting. She keeps getting marks on it from the cleaning products and it’s not easy to look through. Also it creates a distance from her patients.
Normally, the interns do 24-hour shifts on call but in the Covid-19 wards, there are multiple teams doing eight-hour shifts. “Working in PPE for a full 24-hour call would be exhausting, and there’s a very high turnover of patients coming in.”
Moulton’s first task of the day is a difficult one. She heads to the desk at the nurses’ station to find out which patients died during the night. Often she’ll see the names of her friends, fellow doctors, who certified the deaths. “You realise that we’re all in it together.”
She fills out death certificates and then has to call those families who have not been notified yet, which is “a horrible thing.” Often she has to explain to family members why it would be unsafe to come to the hospital to see the body of a loved one, and this is hard to do over the phone. “This is definitely something we’d want to do as a one-on-one conversation.”
The hardest cases are the ones that seem sudden or less expected and Moulton remembers one in particular. A young mother of four had been admitted to the ward and was doing well, but had a rare comorbidity. Moulton was on call one night when she was asked to come to the ward to certify a death, and was shocked to see that it was this patient. “I think that was the first time that I actually cried in front of other people who are also trying to keep it together.” She had to call the woman’s husband and heard the children crying in the background. “It’s been really tough.”
Interactions with patients have changed. Some patients are lonely and not able to see their family. There are no visiting hours in the Covid wards.
After the initial updates, Moulton checks in with patients and goes on ward rounds with seniors. She says one of the highlights of this time is the way medical practitioners from different specialisations have worked together to understand and combat the disease. She describes an amazing camaraderie that she believes has always been there but is coming to the fore now, when senior specialists help with the simplest of procedures, like taking blood samples. ”There’s no form of hierarchy during a pandemic.”
To make the day’s work easier, the group makes a list of which patient needs what and they work their way through it. There are treatments and tests to see to, and new admissions to handle. Often a comorbidity, such as diabetes, is only diagnosed when patients come in with Covid-19 symptoms, so their admission to the ward may involve the management of several diseases simultaneously.
Transferring patients out of the ward takes up some time. In a ward of 25 to 30 beds, as many as eight or nine patients may be transferred on a given day. Moulton makes calls and sends messages for referrals and transfers, and follows the necessary processes to pass on all the important information. “You’re trying to get as many people out and get them home if they’re doing well, or transfer them somewhere if they can go, because you know there’s a full emergency room downstairs waiting.”
On a good day, Moulton may get time for a break. She runs down to her car and sits on the edge, afraid to sit inside and accidentally contaminate it. Her lunches are energy bars or bananas, anything that she doesn’t need to touch too much. A few sips of water, and it’s back to the ward. These short breaks mean she has to go through the full process of doffing and donning PPE. But it’s worth it on days that are so busy that she can forget to go to the bathroom.
The shift ends after a second ward round and when the handover to the next shift has been prepared. Moulton takes her PPE off carefully to be washed or thrown away. In her reflection in the mirror she sees the marks of the mask and visor. She sanitises her car key, pen and phone. At home, she leaves her “corona shoes” at the door, and heads straight to the shower for a thorough wash. “Even though you’ve changed out of PPE, and taken off the hospital clothes, and put on clean clothes, you’re still worried.” Her clothes go into the washing machine, and anything else she may have touched gets sanitised.
Moulton lives alone and frequently calls her boyfriend or a family member, especially if it’s been a tough day, “just to talk through why”.
“Maybe you were just tired, or maybe someone died who you didn’t expect, or maybe today was just a day of deaths.”
She was very frightened on her first shifts. “You have to not let your anxieties and own fears stop you from helping the patients as much as possible.” As time went by, she learned to use the moments before entering the ward to get into a hopeful mindset. “You try and pump yourself up, just realising that you need to be a light for your patients.”
“It’s very rewarding when you know you’ve done all you can for a patient and you see them get home and be discharged.”
Like other healthcare professionals around the country who see the effects of the pandemic every day, her message is simple: take the pandemic seriously. “I’ve seen diversity in terms of everyone who is getting affected,” she says, explaining that she wishes people would understand that anyone could be at risk of a serious form of the disease.
“The reality is the beds are full and people are dying because we can’t accommodate every single person in ICU who needs it.”
“Healthcare workers are tired and working hard and taking strain, just as every essential worker has. It’s the duty of every South African to do their part, to fight this battle, because it is a battle and it’s not going to be a short one.”