Lessons from a near-death experience

Infected with severe Covid during the second wave last year, S Raghotham lived to tell the medical tale, and what happens to an agnostic when he is sinking

On Ugadi, April 13, 2021, following a distress call from my brother-in-law, my wife and I drove down to his house. All five in his family – he, his mother, his wife and two daughters – had tested Covid positive, and his own and his mother’s condition was deteriorating.

For six hours, we stood at their gate, while they sat at the door, trying to obtain hospital beds for them. They lived right behind one of Bengaluru’s biggest private hospitals. It would have been ideal had they got beds there, but we were told it didn’t have any. We got the same response from several private hospitals.

We called up the BBMP Covid Control Room. We were asked to give a ‘BU’ number for each patient. Now, the BU number – to be given by the BBMP as soon as a patient tested positive – had not been generated. One hand of the BBMP was unable to generate the BU numbers, and the other wouldn’t give us beds without those numbers.

Thanks to the efforts of this paper’s health reporter, at about 10.30 pm, the director of a government hospital in Shivajinagar agreed to admit the two without the BU numbers. He was a god-send, if I, a non-believer, may use that expression.

By that time, the two patients’ oxygen saturation levels had begun to drop to the low 80s. We rushed them in our own cars – Prasad’s wife driving the two in their car; and my wife and I leading in our car, through multiple police check points, at each of which we had to explain our situation.

As we entered the hospital premises, two dead bodies were being wheeled out. My wife and I exchanged worried glances, but we had no choice. The hospital was now our best shot.

The junior doctors and staff who were running the admissions process were all in full PPE gear and exhausted, having been on duty for over 12 hours at least already (and they had had no off-day for months, some even for more than a year by then), but they were all most patient, courteous and helpful. The testing and admissions process took until 4 am, when both patients were taken to their beds on the seventh floor of the building.

My wife (who had waited outside all this time) and I drove back home. It was nearly 6 am by the time we reached home to our children – a daughter, 12, and a son, 10 -- who were fast asleep, having managed through the previous day and night all by themselves. We showered and went to bed.

Over the next three days, I made trips to the hospital to give them breakfast, lunch and dinner, and to keep track of their progress with the hospital’s dean and in-charge of the Covid ward. His team had started a WhatsApp group for the families of all patients admitted there, and we were regularly informed of our patient’s condition and treatment. That was wonderful, but as with all government hospitals, the patients got medication according to the Covid treatment protocol, but nursing care and ward services were absent.

Perhaps there were too few paramedical and ward staff, and they all were tired, having been on the Covid battle frontline for over a year. Both my brother-in-law (BIL) and mother-in-law (MIL) were on oxygen support, but my BIL had to frequently take off his oxygen mask to visit his mother in the ladies’ ward to help her with food, taking medicines, etc., and to monitor her oxygen levels. This was worsening his own condition as he would soon run out of breath each time. Also, each time, I went to the hospital, it seemed more dead bodies were being wheeled out. The mortuary was just behind where I was parking my car.

I decided to shift them to a private hospital as soon as possible.

A lucky break came when the cancer hospital chain HCG Hospitals started a Covid centre. I called up Dr Krupesh, the man in charge. After pleading with him for two days, I was able to shift the two patients there – one by one, in the dead of night, with the ambulance breaking down for two hours between the two trips.

At HCG, I did not have to worry about nursing care. Both patients said they were getting excellent care. Nor did I have to take food to them. The hospital provided good quality food. Also, by this time, I had developed cold and cough myself.

But as the patients’ condition was not improving despite giving them the remaining doses of Remdesivir (they had been started on it at the government hospital) and other drugs. The doctors decided to try out platelet transfusion. After seeking blood from the two patients’ blood groups from blood banks, on WhatsApp groups, etc., I finally managed to find a unit for each of them over a period of two days from two different blood banks and gave them to the hospital, which promptly carried out the transfusions. Whether due to this or not, the two patients began to recover thereafter. My MIL was out of the hospital first. My brother-in-law was still in a bad condition but improving steadily, with some experimental drugs also being given to him, one of which left his face painted in multiple colours for a few days. Another cousin, who too was in the same hospital, was also making slow recovery. It was time for me to step back and wait for them to heal. Or so I thought.

I had caught it

But now, around April 22, I began to show symptoms, perhaps from all the exposure I had had. The next day, my wife and I got ourselves tested. The PCR test threw up a false negative for both of us (as was happening to most around the time), but the CT-scan severity score was 17/25 for me, 5/25 for my wife. I had to get admitted to a hospital; my wife could manage at home.

On April 24, by evening, my oxygen saturation level was beginning to drop and I could not spend time and energy making calls. I asked a colleague to help. He called up the BBMP official managing the bed allotment process. Now, in my case, I had the BU number, but my PCR test was negative. So, I could only be admitted to a non-Covid SARI hospital. I was asked to go to the Rajiv Gandhi Institute of Chest Diseases.

Deterioration
The non-Covid SARI ward was a long room with two rows of beds. To my utter surprise, all the other patients had family members – wives, sons, daughters – attending to them. While the patients slept on the beds, the attendants slept on the floor beside the beds. Everyone knew we were Covid patients there. All patients were on oxygen support, and we were being treated according to the Covid protocol. Yet, officially, it was a non-Covid ward, and attendants were allowed!

Here, too, the nurses came around regularly to check sugar levels, give insulin injections, zinc and Vitamin C tablets, and Remdesivir from the second day of admission. But that was about the level of care I would get. For everything else, I was on my own. I would take the oxygen mask off while eating or when I had to walk the long way to the restroom. I would feel dizzy, and would support myself on other beds or the walls as I walked. Nobody seemed to care. In fact, the nurses berated me for not having an attendant with me. The ward staff there were meant to only keep the room clean, not help the patients. I learnt later that one of them even called up my wife and asked her why she had left me to die there!

The doctors – a senior and a junior – said I need not worry at the moment, but warned that they had no ICU, no ventilators. If things got worse, I would have to go elsewhere. This was also a place bereft of mobile connectivity. As a result, I could scarcely communicate with anyone outside. For three days, my wife had scant information about my condition.

Two avoidable deaths

April 27: I was surrounded by patients who were worse, and their suffering was there for all to see. Indeed, on the third day of my admission, two men began to sink rapidly. Had an ICU and ventilators been available, they might have survived. The two died early that evening, as the rest of us watched in horror.

I began to ask myself what I was doing there. Was I going to let myself die like them? As I was trying desperately to reach my wife and colleagues, a junior doctor informed me that from the swabs collected the previous evening, I had tested positive for Covid and so I could no longer stay in that hospital. I was told I had three hours to get out!

My wife had been calling up Dr Krupesh at HCG every day since I left home and pleading to admit me there. Finally, after three days, he had a bed available for me.

The ICU that didn’t stop

As I learnt later from my medical records, when I reached HCG, my oxygen saturation level, without support, was 56%! It had been 84% at the time of admission to RGICD. I was wheeled into HCG’s Covid ICU. It was a sea change from the earlier hospital, and the reason I am alive today. As my doctor told me later, I was put on a non-invasive ventilator with high-flow oxygen. (Fortunately, they did not put me on invasive ventilator, the complications of which became apparent in hundreds, if not thousands, of Covid patients later with the ‘Black Fungus’ and other side-effects).

The change was striking in every respect. The ICU had been set up at short notice – I believe just three days. It was a war-room and a battlefield combined, with a command centre in the middle, and the ICU beds – some 15 – all around it. It was brightly lit day and night, buzzing with alerts from medical devices. Patients were calling for help and making phone calls, and doctors were discussing among themselves the conditions of individual patients.

The paramedical and ward staff were constantly tending to the patients. I was in a bed in one corner of the room; in the bed diagonally opposite was a lady over 80; in the corner directly opposite was a man in his 40s; in the bed along the side between him and me was another woman in her 80s, apparently the mother of one of the doctors at HCG. He came periodically to pep-talk her into cooperating with the treatment, but the lady didn’t seem to respond. I could hear him saying, “Ma, do you want to go home soon? ...” He would repeat this throughout his visit, sometimes walking out of the curtains and throwing up his hands in despair. To my left was a woman who must have been much younger than me, perhaps in her 30s.

Unlike at the earlier hospital, the doctors, the paramedical and ward staff were for the most part in PPE suits. The training had clearly been rigorous, and Covid protocols were strictly followed at all levels.

Here, I was strictly instructed not to take off the oxygen mask even for a minute. While eating, I had to take off the mask, have a spoonful, and put on the mask again. I was to lie down on my stomach, in proning position. As my doctor said later, I did this well and it contributed greatly to my quick recovery.

The nurses would come every hour to monitor BP and sugar, especially sugar, and give insulin injections and tablets. The ward staff would come at 3.30 am to clean me up with a sponge bath and change of clothes. I was to relieve myself in a urine can. To pass motion, I insisted on a commode-chair. This was how it was for the next three days. If he saw me turn ever so slightly from the proning position, Dr Krupesh would come and admonish me: “You are lazy. You expect us to do everything for you!” It was a comment he made to every patient, because he knew what was at stake. It was his way of motivating us to keep up the will to survive.

My experience and impression of hospital ward staff had been mostly negative till then, especially in recent years when my father was constantly hospitalised during his last three years. They whined, they were not committed, they didn’t care much about patient comfort or even the end result of the treatment. But here, it was totally different. Mind you, they were throughout in full PPE, they worked 12-hour shifts or longer, and most of them had been working for months without an off day. Worst of all, when they went home, they always were in danger of carrying the virus to their families. Yet, the ward staff, given the lowliest of tasks, never complained, never whined, never delayed help. There was almost a spiritual quality to the way they conducted themselves.

Post-discharge, when I went for a follow-up check, I asked to meet the ward staff who had attended to me. One was around at the time. I thanked him, I enquired about the others, and I offered to put some money into a fund for them if the hospital had such a fund. I could not think of anything else I could offer to these men and women. The man refused. “This Covid is a chance for us to do some good, to save lives, to realise our highest selves as humans. That you are still with us is reward enough. Your words of appreciation are enough,” he said.

I am not a believer in god or god’s greatness. To me, god does not exist, and even if god does exist, then by definition, god is all-capable and therefore there is nothing great about any miracle such a god can perform. I believe in human beings, instead. Humans are flawed, limited and not all-capable. Therefore, they are capable of greatness – which they can achieve by overcoming their flaws, their limits. Here, in the ward staff, I saw vindication of what I believe in and what I don’t believe in.

Sinking, but saved
April 28: A CT scan revealed that the severity score was now 24/25! Dr Krupesh told me: “Your lungs are damaged 90%. We will do our best. You have to help us.” (I learnt later that his prognosis was even more dire when he spoke to my wife).

For the next two days, I did as I was told (proning, breathing exercises when sitting up, and even taking what was then said to be an experimental immune-suppressant drug that would help Remdesivir do its job). By April 30, I was on the path to recovery, and ready to be shifted to a ward. The oxygen mask was replaced by a nasal cannula. The flow rate was reduced daily. Finally, on May 5, I was ready to go home after I had been without oxygen support for 24 hours.

What I learnt

When you are faced with the possibility that you might not go back alive, a few things happen involuntarily: Images of your dear ones flash by. And there is the urge to pray to God to save you. I’m a non-believer, agnostic to be precise. The last time I prayed was 24 years ago when my mother was dying. I was agnostic even then, but when your mother is dying at 52, it doesn’t matter what you believe in or not. You want to call upon any force at all that can save her. All you can think is, she should not go. When that didn’t work, my unbelieving got more strident with the years.But here I was now, needing to pray to save my own life. For a minute, I did. No mantras, but simply the selfish, “God, I’m too young to die. I have two young children, I can’t just go now. I don’t even have savings or a house that I can leave for them (thinking of such luxuries on a journalist’s salary, are you kidding me!).”

But then, a part of me stepped away and mocked me: “Hmm… such a hypocrite, aren’t you? Suddenly, you want a God you do not believe in to save you!” I virtually slapped myself and snapped out of the self-pity. I can’t stand hypocrisy, not even my own. I said to myself, “If the treatment works, I live. If it doesn’t, then it’s the end. My wife is not a weakling, she can take care of herself and the children. And I have a brother who will support them. Now, let’s go to battle.”

And here I am still.

Throughout this time, at home, my wife was holding it all together, ensuring that the children didn’t panic, all of them praying together, coordinating things that had to be done, giving updates to friends and family, replying to well-wishers…Her colleagues in an ongoing Cambridge University fellowship pooled in a lot of money and sent us an oxygen concentrator from the UK, figuring that I would need it once I got back home.

Before going home, I asked my doctor: Look, it is now being said that Remdesivir is useless, platelet transfusion is useless, and so on. So, what actually worked for me? How did I come out alive?

His reply: “Raghotham, after discharge, you’ll have to rest for two months. You will have plenty of time. Do your own research then, because even we don’t know. You took to proning easily. That certainly helped. And, of course, I know you don’t believe in god, but I do, and I think god saved you.”

We agreed to disagree on that. I think, he and his team saved me. My wife did, by ensuring that I landed up at HCG. That I did not have co-morbidities helped faster recovery. I was lucky in all these respects. And luck is a matter of probabilities, not of a god determining who should live and who should die. Millions of others passed away, entire families got wiped out during the second wave. To think that there is a god who somehow favoured me over all those others whom he let perish seems incongruent, if not vulgar, with the very idea of god.

To me, it seems, with all its faults and failures, the healthcare system in Bengaluru worked for me, and it did because of dedicated men and women.

Perhaps the crucial lesson is that if the BBMP control room had not insisted on the BU numbers, and my brother-in-law and mother-in-law had found beds in the hospital nearby, none of the rest would have followed, and I probably would not have contracted Covid at all. It is this systemic part that needs to work differently during this wave.

The focus must be on saving lives, and not on BU numbers and reporting Covid statistics. Those are important, but they must be secondary to the urgent task of saving lives. If this is kept in view, the system will become much more compassionate.

Secondly, the difference between the private hospital and the government hospital was not in the doctors or the equipment, but in the nursing care and ward services. Government hospitals provided medication according to the protocol, but forgot to tell patients the little things that ultimately made the difference: don’t take off your oxygen masks; maintain proning position, etc. These don’t call for money, just training and unwavering commitment.

This is, of course, a dry narration of what happened over a few days last year, bereft of much of the distress and the struggle behind the scenes at every stage. But a dry narration, minus the drama, is necessary to draw out objective lessons.

Hopefully, the ongoing third wave will not become as severe as the second, and the pressure on the system will not be as high as it was in April-May last year