Cape Town doctor describes her day in a Covid-19 ward

A Groote Schuur Hospital medical intern has described her working days in Covid-19 wards.

Danielle Moulton takes just three things into the hospital with her in the morning: her car key, a pen and her cellphone in a plastic zipper bag. The rest of her belongings stay in the car as her day in the Covid-19 wards in the Cape Town hospital starts.

At work she has a quick cup of coffee and big gulp of water, knowing she won’t get a break for a while. At the entrance to the wards she starts in the clean room, donning her personal protective equipment (PPE).

“This is a war we’re fighting. It sounds super lame, but you’re almost putting on your armour for battle.”

A full set of PPE includes a hair net, booties, a gown, a visor and an N95 mask “which you end up checking a million times during the day”. All of this is worn over her medical scrubs. She also wears her “corona shoes”, an old pair she “is not going to miss at the end of this”.

The process takes a while. At the beginning of their stints in the Covid-19 wards, the interns used a buddy system to put on and take off the equipment. They watched each other to make sure everyone was doing it correctly until they got used to the procedure.

“You become hyper-vigilant. You’re anxious that you’re doing something wrong or that you’re forgetting something.”

Moulton said the visor is the most constricting. She keeps getting marks on it from the cleaning products, and said it’s not easy to look through the visor. It also creates a distance from her patients.

The interns usually 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 difficult. 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 we’re all in it together.”

She completes death certificates and then has to call those families who have not yet been notified, 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 in a one-on-one conversation.”

The most difficult cases are the ones that seem sudden or were not 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 go to the ward to certify a death, and was shocked to see it was the young mother.

“That was the first time I 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 as none are allowed to be visited by family members and friends. There are no visiting hours in the Covid-19 wards.

After initial updates, Moulton checks in with patients and goes on ward rounds with seniors.

She said 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 described an amazing camaraderie 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 hierarchy during a pandemic.”

To make the day’s work easier, the group makes a list of which patient needs what and works their way through it. There are treatments and tests to see to, and new admissions to handle.

Often a comorbidity, such as diabetes, is diagnosed only 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 time. In a ward with 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 to another ward because you know there’s a full emergency room of patients downstairs waiting.”

On a good day, Moulton may get time for a break. She runs to her car and sits on it, afraid to sit inside and contaminate it. Her lunches are energy bars or bananas, anything she doesn’t need to touch too much. A few sips of water, and it’s back to the wards. These short breaks mean she has to go through the full process of taking the PPE off and putting it on again. Some days are so busy that she forgets 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 carefully takes off her PPE to be washed or thrown away.

In her reflection in the mirror she sees marks from the mask and visor. She sanitises her car key, pen and cellphone.

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, have 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 is 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 it was tough".

“Maybe you were tired, or maybe someone died who you didn’t expect to die, or maybe today was just a day of deaths.”

She said she was very frightened during her first shifts.

“You have to not let your anxieties and fears stop you from helping patients.”

As time went by, she learnt to use the moments before entering the wards to get into a hopeful mindset.

“You try and pump yourself up, realising 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 discharged and go home.”

Like other health-care 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 being affected,” she said, adding that she wishes people would understand that anyone is 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 person in intensive care who needs it. Health-care workers are tired, working hard and taking strain. It is the same for essential workers.

"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.”

• This article was originally published on GroundUp.