AJA Asian Journal of Anesthesiology

Advancing, Capability, Improving lives

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Volume 58, Issue 4, Pages 121-123
KS Sushma 1
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Figure 1.
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Figure 1. Coronavirus Basic Statistics, to Date and Change From Previous Day
Data: Ministry of Health and Family Welfare, Government of India.
Image: https://www.ndtv.com. Ignore commas to convert the Indian numbering notation system for large numbers (≥ 100,000) to the Western system.

Every crisis creates heroes: those who by instinct rush into the fray of battle while others run away, or at least react with greater circumspection. The onset of the 2019 pandemic drew us anesthesiologists to battle stations, but as ill-prepared and ill-equipped warriors, relatively clueless about the nature of the enemy we faced. While the boldest or most heedless among us charged forward, most of us hesitated or struggled, at least initially, to hold our ground—entering, along with our personal anxieties, into a moral calculus the notion of dragging our loved ones onto a battlefield they had never signed up for. Uneasy about the sharpness of our swords and the strength of our armor, we reluctantly donned the crown of corona warrior.

For the first time in our lives, we stood as in the boots of soldiers on the front lines, prepared to risk our lives for the sakes of others. And as soldiers do, we held steadfast, bound by our sense of duty.

It is said that a leader is one who knows the way, goes the way and shows the way. When chalking out a battle plan, seasoned military officers know what they are asking of their battalions because they have fought those battles themselves in their younger days. But pandemics being rare events, few of the leaders who drew up plans to fight the disease knew the way: they had never experienced what they sent their soldiers to fight each day. Unless they had experienced the incapacitating personal protective equipment (PPE), they could not have known the suffocating constrictions it imposes on executing those plans of treatment. Such leaders cannot be simplistically or completely blamed for not going the way with their troops, as advanced age often precluded them from fighting alongside on the front lines. They did a good job in inspiring us, keeping us motivated, and showing us appreciation for our work and sacrifices.

As my country, India, went into lockdown and most people confined themselves safely at home, we drove on empty streets to full hospitals, fearing for our lives as we approached the front lines. While we struggled treating coronavirus disease (COVID) patients in our PPE, anesthetizing supposedly non-COVID patients posed an even more challenging labor. Theretofore mundane routines—pre-anesthetic evaluation, IV access, spinal anesthesia—became onerous, encumbered as we were in order to protect ourselves from an invisible enemy. Effecting an intubation created a dread comparable to standing near an overheating nuclear reactor.Intubation—ordinarily a procedure performed by a variety of physicians, now a high-risk enterprise—suddenly fell into the sole province of anesthesiologists, ostensibly due to our expertise. We anesthesiologists, who once prided ourselves as masters of airway management, now struggled through fogged glasses, face shields, thick walls of intubation boxes—into the inflamed and edematous airways of COVID patients. High viral load and risk of aerosolization could render undertaking the procedure to feel almost suicidal. Dismal outcomes with mechanical ventilation in COVID patients deflated our morale all the more.

Figure 2.
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Figure 2. A Healthcare Worker Checks a Woman’s Temperature in New Delhi, September 27, 2020, Shortly After India’s New Case Wave Peaked
Photo: Sanjeev Verma/Hindustan Times.

Social media was both boon and bane in those testing times when the initial surge of cases overwhelmed us. The webinars and emerging literature provided insights into wh was happening with a timeliness never before experienced in a global pandemic. Concomitantly, however, vast quantities of misinformation pinged us via instant message broadcasts and Facebook pages, creating confusion, fear, even panic. There were heart-bruising periods of waking daily to news of deaths of colleagues infected in the line of duty. Story after story left us desolate.

But the human spirit defies all. Every day we braced ourselves and renewed the commitments that healers make to humanity.

More effective drugs and techniques evolved in the management of the disease. There were days when patients were discharged and our hearts surged with pride, only to plunge again with equal force into helplessness and despair as we saw patients succumb despite the best possible treatment. As we passed through all the phases of the fear cycle, from panic, to inertia, to coping, things seemed to steady. Even as several colleagues became infected with the virus, peer support and mutual assistance buoyed us. We held on to each other through these trials, albeit virtually. We prayed for one anesthesiologist who, while himself receiving oxygen therapy, performed emergency intubation on a sinking patient. We applauded a group of anesthesia postgraduates who heroically saved all the patients from an accidental fire in a COVID ICU. Historically the invisible medical specialists despite our vital role in the healthcare enterprise, especially vis-a-vis crisis situations, anesthesiologists were suddenly elevated into global public consciousness as one of our own was featured on the esteemed cover of TIME in April of 2020.

Figure 3.
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Figure 3. TIME Magazine Recognizes Anesthesiologists s Heroes of the Front Lines, Featuring this mage as One of Five Special Covers for its April 20, 2020 Issue
Photo: Lorenzo Meloni/Magnum Photos for TIME.

The pandemic was attended by a parallel crisis at home. Most professional-class Indian families rely on domestic help for housekeeping and childcare support. The burdens suddenly fell to working parents, especially mothers, as the lockdown shut our helpers into their own homes. In some ways this was a blessing in disguise as everyone in the family pitched in on the chores, taking turns cooking healthy and sustaining dishes. The little heroes at home, bombarded with news of suffering and death, and confined indoors, quickly rose to the occasion: coping and inspiring at the same time. A holistic approach to health was order of the day with ample fruits and veggies and exercise routines.

India’s 1.4 billion people have seen a dramatic waning of the “first wave”, and look ahead to a promising but complex and daunting vaccination effort. We currently suffer the world’s second-highest caseload at almost 10 million cases and more than 140,000 deaths as I write. Even as the scale of human distress and suffering has marked us for life, so too has it strengthened our resolve. We will wake up tomorrow, don our battle-gear, and continue the perilous journey. Holding, as we march, onto the core of our existence, our families.

Writing Assistance

James L Reynolds, The Asian Journal of Anesthesiology.

The Asian Journal of Anesthesiology welcomes personal perspectives of anesthesiologists and related others on the question “What is or has been important to you with respect to the COVID-19 pandemic, and why?” Above all else, we seek statements that are simple, human, authentic, and heartfelt. Writing assistance is available at no cost, and contributions may be made by verbal interview as well as in writing. Submissions or questions to: James L Reynolds, globalization editor (jrAsianJournalAnesth@gmail.com).

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