It was not until the night before she was expected to join the ‘coronavirus rotation’ that Mridula S. Sree informed her parents. The rookie nurse, barely half a year into her career at Government TD Medical College Hospital in Alleppey, was apprehensive already about the prospect of being in a room with COVID-19. The isolation ward is a lonely, discomfiting space. As a student at the Government College of Nursing nearby and then over her internship, Mridula had heard stories about the ward and the stresses it places on nurses.
“It’s just you and the patient in a spare, bright room with two doors…a designated entrance and exit to be used exclusively as such. An attendant sits outside just in case, but once you enter, that door is almost never opened till you are relieved of duty. It takes some getting used to,” Mridula says. Her first stint in the isolation unit came in February after a medical student returnee from Wuhan—India’s second confirmed coronavirus case—was housed there. He was discharged on February 13 after consecutive negative tests.
Speaking to Outlook ahead of a second rotation—though no additional positives have been reported at TDMC as of going to print, a number of suspected cases are under observation—Mridula says the fear never really goes away. “But it is our duty to work through our doubts and worries. Those four-hour shifts in the isolation ward (no meals or bathroom breaks allowed) are more difficult than our six-hour ones in the medical ward,” the 26-year-old says.
Part of the experience is getting past the knowledge that only a few layers of personal protective equipment (PPE)—a stifling environment in itself—separates her from a contagious disease. The PPE, a hazmat suit, offers head-to-toe coverage—from a hoodie-like head covering, to wide-cover goggles and N95 respiratory mask (all of which taped together to ensure a tight seal), a puncture-resistant jumpsuit, tight-fitting heavy gloves, disposable boot covers and an apron to top it off. No jewellery or accessories are allowed—save a regularly-sanitised mobile phone with only numbers of team members entered.
“It is sweaty and suffocating since the mask restricts air flow. Even if sweat gets into your eyes or brow or if you have an itch, you can only ignore the irritation and control yourself. Once in the suit, you have to condition yourself to not touch your face or expose any skin till the shift ends. And even then, there is a special way to remove the suit to avoid coming in contact with it again,” she says. Once removed, the suit is carefully discarded into biomedical waste bags in the exit area.
The exit section has an attached washroom and scrub area. The shift-end procedure involves a soap shower and a soak of the uniform in Dettol and water. An attendant brings their clothing and bags through a separate door. On reaching her room in the hostel, another shower and Dettol soak completes the rinse and repeat regimen. Mridula had the benefit of established guidelines to fall back on. Not to mention an experienced command and support structure comprising the college superintendent, medical officers, PG doctors, house surgeons, nurses and nursing assistants and cleaning and waste disposal staff.
“Besides giving him his medicines and conducting the routine checks, the best part of the shift was interacting with the patient. But in four hours, you quickly run out of things to talk about. The silences can be tough too if you are accustomed to workplace noise,” she says.
Mridula’s run in the isolation ward coincided with the patient’s discharge. Afterward, she wrote about her experiences in a Facebook post (since deleted because “I felt I was being glorified” while the rest of the team’s efforts went unappreciated) that went viral. Accolades and attention followed. Not altogether welcome since it is something of an unwritten rule among nurses that ‘what happens in the ward stays in the ward’. “The only time the general public is aware of a nurse’s name is if something happens or they get an award. Like Sister Lini,” says Mridula, referring to the heroic nurse who lost her life after being infected with Nipah virus while attending to a patient during the 2018 outbreak in northern Kerala. For Mridula, she is a source both of inspiration and dread. She is now bracing for another stint in the coronavirus rotation. “I wish they would do something about the chair in that room.”