Makati Medical Center ICU Doctor Tells Us What It Is Like Inside A Hazmat Suit
Dr. Melissa Bernardo is an intensivist with Makati Medical Center (MMC) who has been doing critical care work for over 12 years now. Pre COVID-19, she was not on duty full-time but this unprecedented pandemic has brought a heightened level of urgency and even desperation to both the emergency room (ER) and the intensive care unit (ICU.)
“The sheer number of people needing ICU care is unbelievable; and truly, without trying to exaggerate, it seems apocalyptic” Dr. Bernardo says honestly. She continues saying that the Makati Medical Center ICU is full with the surge of critically ill COVID-19 patients all needing mechanical ventilator support. Most who are admitted into the ICU end up medications to raise their blood pressure and several even need dialysis.
There is a lack of comfort I can give to my patients because I know they can’t see my face [through the goggles, masks and hazmat suits]. I cannot touch their hands without my double gloves. I look into my patients eyes trying to convey hope all the time, even if I'm not entirely sure how they will fair.
Dr. Bernardo’s typical routine revolves around cardiac critical care. Unfortunately, she has become accustomed to dealing directly with the affected patients' emergency contacts and next of kin to explain their predicament since many are critical and unable to communicate themselves, either because of their profound illness or due to sedatives needed to lessen their “air-hunger”. Another factor that makes her routine more challenging, both physically and emotionally, is the literal barrier that her Personal Protective Equipment (PPE) creates.
Doctors are trained to have a certain bed-side manner, a way of calming, soothing and assuring frightened patients. But now, this layer of comfort for admitted patients has been abrasively disrupted. She said that “even between us staff, we can't readily recognise each other. There is a lack of comfort I can give to my patients because I know they can’t see my face [through the googles, masks and hazmat suits]. I cannot touch their hands without my double gloves. I look into my patients eyes trying to convey hope all the time, even if I'm not entirely sure how they will fair.”
I can’t say I am particularly motivated by any single reason other than this is what I do and this is what I signed up for to take care of the sick. I don’t want to be a hero. We are all afraid but this is what we do, this is our life compass to alleviate sickness.
— Dr. Melissa Bernardo
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What protects her also breaks her heart. Unable to ease her patients' worries and provide a more personal, human element to practicing medicine adds to the patients' trauma and drains physicians' spirits too. She explained that the experience is made more heartbreaking because of the fact that COVID-19 positive patients cannot even be comforted by their loved ones as they can be no where near them. Even when someone dies, the family cannot be with the body or arrange any ‘normal’ funeral services.
The PPE hazmat suits are made of thick medical grade plastic which is hot and uncomfortable, to say the least. There is a strict and meticulous process for how to suit-up. “The N95 mask, head caps, booties, double gloves, splash resistant gown, goggles and face shields must be put on carefully to not to leave any skin exposed.” Dr. Bernardo said that when it was her first day to enter the ICU as a frontliner against COVID-19, she was terrified. “I have never been more nervous putting on a PPE... I know how contagious COVID-19 is and I have seen how it can cause acute respiratory distress syndrome (ARDS) from the news coming from different countries. Apart from being afraid of getting infected, it equally bothers me that I might inadvertently take home the virus and infect my elderly aunt or my young daughter.”
When doctors wear the full PPE sometimes they do so for around eight hours at a time, and thus must learn to live with this claustrophobic and suffocated feeling. A lot of them feel almost dizzy because of the heat and constriction, which is why you see many images circulating the internet of physicians with scars from their masks. These frontliners have to even limit their bathroom time because once you remove a PPE hazmat suit, you have to dispose of it (if it is single-use) or send it out for cleaning, meaning that they must wear an entirely new suit post-bathroom. With limited PPEs, they have to maintain a strict schedule to make the most of the supply.
I asked Dr. Bernardo what frustrates her about COVID-19. She said that what bothers her the most might be that they do not know how to beat it. That she cannot make her patients well, no matter how hard they fight. “This disease is a battle of outlasting the virus, letting the body heal on its own and us trying to buy time for the patient without any proven medication to positively kill this virus. I am scared the most that our healthcare system might reach its breaking point and we have to make tough choices that no doctor will ever want to make,” she elaborated. Hinting that soon, physicians may have to decide who is most deserving of treatment.
“Physical and mental exhaustion is not new to doctors; all the years of training, and being a consultant has made us ready to take on our jobs—[we're] used to missing meals and skipping bathroom breaks,” she said when I asked her about how she is able to cope with being an intensivist during a time when her services are in extremely high demand in comparison to the pre COVID-19 ICU.
She said that to calm down and de-stress she tries be still for even just 15 minutes—to sit on a lazy-boy and have some quiet time in a separate unit in MMC . “When I'm not on duty, we scour journals, webinars and scientific recommendations to try to improve the patient's care and survival. With the help of my colleagues including nurses and pharmacists we try to improve workflow by making algorithms. I’d like to do more yoga but I guess I'm just too preoccupied to sustain it.” Even on her days off this doctor cannot get work out of her mind. This disease haunts our fronliners and follows them at all hours of the day. Doctors' minds are constantly buzzing.
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I know [doctors] are overwhelmed but they stepped up to the challenge. The disease in itself, when severe, is unlike much of what I have seen before... It is quick and relentless. We don’t really know what medicines are working and what are not, which makes it all the more frustrating.
— Dr. Melissa Bernardo
Dr. Bernardo made us understand how overwhelming it has been. "The line to be admitted in the ICU is constantly long. We needed to convert another critical care unit into a COVID unit almost overnight. We needed to teach them how to prone a patient, which is a technique used to recruit more unaffected lungs to improve ventilation. We had to adapt quickly to accommodate the patients pouring in from the ER.”
It was definitely a challenge to create more ICU centres because of the amount of requirements and extra precautions to protect against COVID-19. “It must be negative pressure and the entry is restricted to both limit exposure and spread of the virus, forcing us to make a lean but complete medical team.” The supervising intensivists like Dr. Bernardo had to rapidly train nurses, doctors and residents in MMC’s regular floors which were converted into COVID wards.
They all had to become accustomed to ICU level care for critical patients—it is a wealth of information that is difficult to digest. To which Dr. Bernardo said, “I know they are overwhelmed but they stepped up to the challenge. The disease in itself, when severe, is unlike much of what I have seen before... It is quick and relentless. We don’t really know what medicines are working and what are not which makes it all the more frustrating.”
This heavy burden is extraordinary these days. I asked what motivates this strong, brave and inspiring woman, to be a frontliner in MMC—and in the ICU at that—where she treats the most brutal cases. To which she replied, “I can’t say I am particularly motivated by any single reason other than this is what I do and this is what I signed up for to take care of the sick. I don’t want to be a hero. We are all afraid but this is what we do, this is our life compass to alleviate sickness.”
One message she does want to get across to all of her patients, to all COVID-19 victims in general, is this: “To all the patients who succumbed to the virus, I hope that [you’ve] felt we tried our best to help [you] and make [you] comfortable, and to [your] families and friends… please know that it breaks our hearts when we cannot do more.”
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