In the Frontline Against an Invisible Enemy: Keralite Healthcare Community in the Midst of a War (Paul D Panakal)
Published on 26 April, 2020
As an RN, Johnson went to bed on Saturday night with mixed feeling of fear, anxiety and uncertainty. He was aware that returning from work after seeing what was going on in the hospital the previous evening was almost traumatic. Johnson does not work in the frontline with the critically ill patients in the ICU or patients arriving in the Emergency Room. Still he witnessed his colleagues desperately trying to help men and women of all ages to breath or to get some oxygen in their body system. With the highly contagious virus invading and disabling their lungs, patients labored to get some air, for some oxygen to maintain their life. Some were conscious, some unconscious and some in conscious sedation. The nurses and doctors knew that their lives are in their hands. Yet, they knew they are not tooled or equipped to contain the killer virus. Johnson saw his colleagues helplessly calling the doctors to see if they could still instill some beats in the patients’ still hearts. As many bodies of the failed lives were moved to the made-up morgues in refrigerated trucks, the healthcare workers had no time for a sigh of grief, frustration, or sadness as more and more critically ill patients were being brought in for their care.
Working with moderately or severely ill COVID patients, Johnson feared that he might have contracted with novel coronavirus. So, when returned from work, he went directly to the basement, put everything in the washer, took shower, put on fresh clothes, before he started his role as a husband and father. Because Johnson was working with less critically ill COVID patients, he knew that despite using personal protective equipment, he was still at risk. Many of those patients were somewhat mobile and were not very mindful in covering the cough and sneeze. He still maintained a physical distance from his wife and children and used his basement as his bed room. Because Johnson was working with less critically ill COVID patients, he knew that despite using personal protective equipment, he was still at risk for contracting the virus. As he lied tossing and turning several hours in bed, he was thinking about his colleagues, the patients and their families.
As he woke up after a couple of hours of nightmarish sleep, Johnson opened his social media pages and news sources to learn what was happening outside of his small hospital and home world. What he learned was that four people from Malayalee community that he personally knew died from the complications of COVID. All of them died in the hospital; all of them were on ventilators; none of their loves ones was with them in their last moments to give emotional comfort, support of prayer, or to feel the consolation of saying bye.
Johnson, back at work, forgot what was behind him as he reached his work. He worked with three other RNs and a nurse manager on a 24-bed medical floor. The previous evening, as he left the work, the unit was filled with COVID patients that were not critical. This morning as he returned, he was received by his nurse manager who always maintained a calm demeanor and a friendly smile. She told him that the situation in the hospital changed rapidly. Due to the influx of patients, makeshift hospital has been built in parking lot and in cafeteria. The hospital staff team will have to share the added capacity in their hands. As a result, two other RNs on the unit have been moved to the extended hospital and the nurse manager, Johnson and a third RN were to take care of the moderate to severely ill patients. Johnson told the nurse manager: “I understand. It is that time. We are made for this. We will do it to the best of our ability. We will comfort our patients as best as we could”. The nurse manager nodded with a painful smile. Most of the patients on the unit were receiving oxygen treatment, IV antibiotics and some were on medications under study to test their efficacy. Most of the patients were elderly and needed assistance in getting out of their beds and to use bathrooms. Call bells sounded constantly from room to room with calls for help. Some wanted to change their positions in bed like moving to the side or elevating head of bed, in some rooms IV fluid or IV medication ran out, there were patients calling with pain, infiltrated IVs, with difficulty breathing, or with physical needs. The three nurses moved from room to room, to electronic medical records to electronic medication bins or to the utility rooms or attending phone calls. They prioritized the severity of the needs and met critical needs while being vigilant of every patient and their medical conditions. The patient care associate who was used to assisting the RN for six to eight patients relentlessly moved around on the unit of 24 patients, assisted patients, took vital signs, communicated with the nurse manager and Johnson. The unit clerk was constantly taking phone calls, dealing with anxious and desperate families, being careful not to violate privacy laws and transferring the lines to the RN or the MD to further assist them.
Johnson later learned that the hospital experienced a surge of patients with COVID with a volume that was three times larger than its capacity. Condition in other hospitals was not different. As the hospital was emergently augmenting the resources including capacity, healthcare workers, ventilators, personal protective equipment and all medical resources, hospital was doing everything possible to save the lives of people brought to it. He also learned that the employees elevated themselves to accept the challenges as their duties and inherent responsibilities.
During the course of the day, healthcare workers including doctors, nurses, social workers, patient care associates, respiratory therapists, unit clerk, and housekeepers lived in pain and despair, death and grief, comfort and pleasant discharge. At the end of the day, after handing the patients off to another RN, Johnson returned home with deep, suppressed emotions, feelings mixed with altruism, despair, helplessness, sadness and uncertainty and to learn that more people from his social contacts were succumbed to COVID.
Johnson is one of the hundreds of Malayalee Registered Nurses in New York that proudly, painstakingly, and resiliently was providing professional nursing care to thousands of and thousands of people infected with SARS-CoV-2, the virus that causes COVID-19. Queens, the hardest hit epicenter in New York which was the epicenter of world in COVID spread is also home for a large Indian community, a major group of which is Malayalees with a considerable number being healthcare professionals. Thanks to the cultural, social and religious organized activities and initiatives, most of the people enjoy and share extensive social relationship among the community. Within a period of two weeks, the community experienced the loss seventeen people, including a RN.
Anni John, an ICU RN from Queens General Hospital was sharing her experience with balanced emotions. “It is still a challenge providing support to save life, protecting myself from getting infected and from transmitting the virus to my children, husband and other family members.” She insisted that the doctors, nurses and other healthcare workers do everything humanly possible to save people’s lives. Anni sighed “it’s a new kind of illness where we do not know what would work to help patients suffering from the complications of COVID.” Dr. Celine Poulose, a physician working in an Emergency Room was leading the team to intubate a patient, but did not know that the patient was with COVID as the cases were prominent. The pandemic was far away and the attack of the infectious disease seemed remote. She learned later that the patient was suffering from COVID. “I immediately went in quarantine”. As she started experiencing fever and flu symptoms, she tried to get a COVID test, but was told that she did not meet the criteria. It was just the beginning of the COVID outbreak here and tests were controlled by the State and were very limited. The physician required hospital’s interventions to get tested. She expressed relief that her symptoms were not serious and she is back in the Emergency Room to treat the incoming patients. Nisha John, another ICU RN from Lenox Hill Hospital was also emphatic on her mission as a RN to provide for healing, to save life or to provide comfort to those in pain or despair. She said she has been self-quarantining for several weeks with the fear of transmission to her family. She said even after she tested negative, she avoids close contact with her children. Annie George, a nurse educator and administrator at HHC was appreciative and impressed as to how quickly our strong healthcare system mobilized the resources to fight the invisible enemy. It’s not at all easy to see the refrigerated trucks as temporary morgues filled with corpses. However, Annie was proud to say “the attributes of readiness and determination of the doctors, nurses, respiratory therapists, and the dietitians that came from the army reserve were like the frontline forces in a real war!”.
Over the last ten days the community experienced the loss of many individuals within it which included a 21-year-old son of a community leader. The saddest part is that the departure from life without the presence of a loved one and the families’ inability to cope with the shock and grief by the unprepared, unanticipated death. Besides the pain, the families found it difficult to get the bodies released to funeral homes. The funeral homes in the area were far beyond their bounds to accept requests from families. Hospitals that were overwhelmed with the unprecedented number of corpses were struggling to find places to put them. “We can’t finger point at anything or fault at what has been happening.” Tara Shajan, a nurse administrator and president of Indian Nurses Association of New York was assertive of how New York has been overcoming and managing the attack of the virus that came like wildfire. “We lost a lot of precious lives. Considering the number of COVID positive cases, the death rate has been very low. Except for some, most of the people that lost their life had had serious comorbidities. Our doctors, nurses and other healthcare workers have been helping to recover and saving thousands of precious lives”. Gisha Jose, a nurse manager who became COVID positive and recovered was trying to recall her experience that she was having the symptoms of seasonal allergy that she gets at this time of the year. “But when I lost my sense of smell, that’s when I decided to go tested. There was a lot of anxiety when I got the result that I’m positive. Having to quarantine myself away from all of my loved ones only made that worse. I had to remind myself that it was the best thing to do for everyone”.
Malayalee healthcare community, being part of the larger mainstream society and healthcare system is visible in all healthcare facilities throughout the metro region as professional or ancillary staff. As reports emerged of the high risk for COVID outbreak, no one imagined that it would hit as rapid as this crisis and overwhelm the emergency and catastrophic resources including protective equipment causing a panic situation. While majority of the COVID positive individuals remained home with symptoms that were not life threatening, cases that came hospital emergency rooms were critical. As with others, nervousness, anxiety and fear overwhelmed all those who were called upon to respond as the only source for those that were fighting for life. As they provided care and comfort, many of them became ill and recovered. They became more resilient. Despite the hardships, risks, hurdles, and challenges, the healthcare professionals in the community remains resilient, find pride and became more altruistic.
Working with moderately or severely ill COVID patients, Johnson feared that he might have contracted with novel coronavirus. So, when returned from work, he went directly to the basement, put everything in the washer, took shower, put on fresh clothes, before he started his role as a husband and father. Because Johnson was working with less critically ill COVID patients, he knew that despite using personal protective equipment, he was still at risk. Many of those patients were somewhat mobile and were not very mindful in covering the cough and sneeze. He still maintained a physical distance from his wife and children and used his basement as his bed room. Because Johnson was working with less critically ill COVID patients, he knew that despite using personal protective equipment, he was still at risk for contracting the virus. As he lied tossing and turning several hours in bed, he was thinking about his colleagues, the patients and their families.
As he woke up after a couple of hours of nightmarish sleep, Johnson opened his social media pages and news sources to learn what was happening outside of his small hospital and home world. What he learned was that four people from Malayalee community that he personally knew died from the complications of COVID. All of them died in the hospital; all of them were on ventilators; none of their loves ones was with them in their last moments to give emotional comfort, support of prayer, or to feel the consolation of saying bye.
Johnson, back at work, forgot what was behind him as he reached his work. He worked with three other RNs and a nurse manager on a 24-bed medical floor. The previous evening, as he left the work, the unit was filled with COVID patients that were not critical. This morning as he returned, he was received by his nurse manager who always maintained a calm demeanor and a friendly smile. She told him that the situation in the hospital changed rapidly. Due to the influx of patients, makeshift hospital has been built in parking lot and in cafeteria. The hospital staff team will have to share the added capacity in their hands. As a result, two other RNs on the unit have been moved to the extended hospital and the nurse manager, Johnson and a third RN were to take care of the moderate to severely ill patients. Johnson told the nurse manager: “I understand. It is that time. We are made for this. We will do it to the best of our ability. We will comfort our patients as best as we could”. The nurse manager nodded with a painful smile. Most of the patients on the unit were receiving oxygen treatment, IV antibiotics and some were on medications under study to test their efficacy. Most of the patients were elderly and needed assistance in getting out of their beds and to use bathrooms. Call bells sounded constantly from room to room with calls for help. Some wanted to change their positions in bed like moving to the side or elevating head of bed, in some rooms IV fluid or IV medication ran out, there were patients calling with pain, infiltrated IVs, with difficulty breathing, or with physical needs. The three nurses moved from room to room, to electronic medical records to electronic medication bins or to the utility rooms or attending phone calls. They prioritized the severity of the needs and met critical needs while being vigilant of every patient and their medical conditions. The patient care associate who was used to assisting the RN for six to eight patients relentlessly moved around on the unit of 24 patients, assisted patients, took vital signs, communicated with the nurse manager and Johnson. The unit clerk was constantly taking phone calls, dealing with anxious and desperate families, being careful not to violate privacy laws and transferring the lines to the RN or the MD to further assist them.
Johnson later learned that the hospital experienced a surge of patients with COVID with a volume that was three times larger than its capacity. Condition in other hospitals was not different. As the hospital was emergently augmenting the resources including capacity, healthcare workers, ventilators, personal protective equipment and all medical resources, hospital was doing everything possible to save the lives of people brought to it. He also learned that the employees elevated themselves to accept the challenges as their duties and inherent responsibilities.
During the course of the day, healthcare workers including doctors, nurses, social workers, patient care associates, respiratory therapists, unit clerk, and housekeepers lived in pain and despair, death and grief, comfort and pleasant discharge. At the end of the day, after handing the patients off to another RN, Johnson returned home with deep, suppressed emotions, feelings mixed with altruism, despair, helplessness, sadness and uncertainty and to learn that more people from his social contacts were succumbed to COVID.
Johnson is one of the hundreds of Malayalee Registered Nurses in New York that proudly, painstakingly, and resiliently was providing professional nursing care to thousands of and thousands of people infected with SARS-CoV-2, the virus that causes COVID-19. Queens, the hardest hit epicenter in New York which was the epicenter of world in COVID spread is also home for a large Indian community, a major group of which is Malayalees with a considerable number being healthcare professionals. Thanks to the cultural, social and religious organized activities and initiatives, most of the people enjoy and share extensive social relationship among the community. Within a period of two weeks, the community experienced the loss seventeen people, including a RN.
Anni John, an ICU RN from Queens General Hospital was sharing her experience with balanced emotions. “It is still a challenge providing support to save life, protecting myself from getting infected and from transmitting the virus to my children, husband and other family members.” She insisted that the doctors, nurses and other healthcare workers do everything humanly possible to save people’s lives. Anni sighed “it’s a new kind of illness where we do not know what would work to help patients suffering from the complications of COVID.” Dr. Celine Poulose, a physician working in an Emergency Room was leading the team to intubate a patient, but did not know that the patient was with COVID as the cases were prominent. The pandemic was far away and the attack of the infectious disease seemed remote. She learned later that the patient was suffering from COVID. “I immediately went in quarantine”. As she started experiencing fever and flu symptoms, she tried to get a COVID test, but was told that she did not meet the criteria. It was just the beginning of the COVID outbreak here and tests were controlled by the State and were very limited. The physician required hospital’s interventions to get tested. She expressed relief that her symptoms were not serious and she is back in the Emergency Room to treat the incoming patients. Nisha John, another ICU RN from Lenox Hill Hospital was also emphatic on her mission as a RN to provide for healing, to save life or to provide comfort to those in pain or despair. She said she has been self-quarantining for several weeks with the fear of transmission to her family. She said even after she tested negative, she avoids close contact with her children. Annie George, a nurse educator and administrator at HHC was appreciative and impressed as to how quickly our strong healthcare system mobilized the resources to fight the invisible enemy. It’s not at all easy to see the refrigerated trucks as temporary morgues filled with corpses. However, Annie was proud to say “the attributes of readiness and determination of the doctors, nurses, respiratory therapists, and the dietitians that came from the army reserve were like the frontline forces in a real war!”.
Over the last ten days the community experienced the loss of many individuals within it which included a 21-year-old son of a community leader. The saddest part is that the departure from life without the presence of a loved one and the families’ inability to cope with the shock and grief by the unprepared, unanticipated death. Besides the pain, the families found it difficult to get the bodies released to funeral homes. The funeral homes in the area were far beyond their bounds to accept requests from families. Hospitals that were overwhelmed with the unprecedented number of corpses were struggling to find places to put them. “We can’t finger point at anything or fault at what has been happening.” Tara Shajan, a nurse administrator and president of Indian Nurses Association of New York was assertive of how New York has been overcoming and managing the attack of the virus that came like wildfire. “We lost a lot of precious lives. Considering the number of COVID positive cases, the death rate has been very low. Except for some, most of the people that lost their life had had serious comorbidities. Our doctors, nurses and other healthcare workers have been helping to recover and saving thousands of precious lives”. Gisha Jose, a nurse manager who became COVID positive and recovered was trying to recall her experience that she was having the symptoms of seasonal allergy that she gets at this time of the year. “But when I lost my sense of smell, that’s when I decided to go tested. There was a lot of anxiety when I got the result that I’m positive. Having to quarantine myself away from all of my loved ones only made that worse. I had to remind myself that it was the best thing to do for everyone”.
Malayalee healthcare community, being part of the larger mainstream society and healthcare system is visible in all healthcare facilities throughout the metro region as professional or ancillary staff. As reports emerged of the high risk for COVID outbreak, no one imagined that it would hit as rapid as this crisis and overwhelm the emergency and catastrophic resources including protective equipment causing a panic situation. While majority of the COVID positive individuals remained home with symptoms that were not life threatening, cases that came hospital emergency rooms were critical. As with others, nervousness, anxiety and fear overwhelmed all those who were called upon to respond as the only source for those that were fighting for life. As they provided care and comfort, many of them became ill and recovered. They became more resilient. Despite the hardships, risks, hurdles, and challenges, the healthcare professionals in the community remains resilient, find pride and became more altruistic.
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