Step Inside The Makati Medical Center Emergency Room During This New Normal
These days, we cannot see our enemy. This is possibly the toughest battle doctors may face in our lifetime. Hospital emergency rooms (ER) have become minefields, where they carefully navigate their way around patients who are all assumed to be COVID-19 positive, until proven otherwise.
“These times are defining moments for doctors and [frontliners]. In normal times it is heart attacks, strokes, accidents, etcetera. But these days the bulk is definitely COVID-19 patients,” shares Dr. Luchangco. He explained to me that to be an ER doctor means being ready to take on anything that comes through the door. “Anything, no matter how horrible. It is making the promise that there is always somewhere to run to 24/7, any day of the year.”
A great many frontliners manning the ER during this pandemic are residents: freshly certified doctors who are in intense training programs to further specialise. These young talents are bravely taking to the frontlines largely due to the fact they are young, and thus more likely to recover from COVID-19. Welcome to the most intense residency program yet!
It is in the face of this uncertainty that we can see the separation of those who respond to the call and step up into harms way and those who step back and exclude themselves
Holding down the Makati Medical Center (MMC) ER fort alongside its residents are their superiors, selfless medical consultants like Dr. Luchangco, who have a higher risk of deteriorating from the disease simply due to the fact that they are older. He explained that they had to pull out older doctors, and those with comorbidities. Then little by little, physicians of all specialties volunteered to step into the frontline as their peers fell ill. “This is a historic health battle for our generation,” Dr. Luchangco proclaimed, “the enemy is formidable and there is much to be done if we hope to win. As a doctor in such times, we are defined by whether we choose to face the threat, or wait it out behind the scenes.”
Dr. Gawaran, head of his batch, was named chief resident for emergency medicine and is now helping lead his peers. “I have always been fascinated with epidemics and outbreaks from an academic viewpoint. Science can predict the patterns of the epidemics, but how societies respond will be different. The interaction of science and society reveals who we truly are as a community,” commented Dr. Gawaran. He shared that pre COVID-19, the ER was already incredibly busy, with a variety of cases—from life-threatening conditions or traumas to patients who come in due to coughs, dislocated shoulders, or small wounds. “We resuscitate patients left and right, every day. A lot of us are adrenaline junkies, one way or another,” Dr. Gawaran adds. “As residents we usually have 12-hour shift duties, barely sitting. We have hurried meals and bathroom breaks, but we get to laugh and eat together after duty,” he continued, shedding some light of their pre-COVID-19 existence.
Every day, we wake up not knowing if it gets better or worse, but we still drink our coffee, go to work, try to save lives, heal more patients, and pray that we do not get sick in the process
— Dr. Austine Gawaran
Patients lie. People forget. Dr. Luchangco, who works in the acute and critical COVID-19 area of the ER says that times have changed drastically and that confirming whether his patients are COVID19 positive or not is practically immaterial to his daily duties at this point. He straightforwardly stated that the MMC ER is a COVID-19 war zone. “In the earlier days we used to segregate people into COVID-19 suspects or not, based on criteria, like travel or certain symptoms. But when we were doing that, some COVID-19 patients slipped through the filters and got put in supposed “clean” zones where the staff were not adequately protected,” he elaborated.
“Busy is an understatement,” a fatigued Dr. Gawaran chimed in. “There is this solemn eerie hum that fills the air, like everybody’s waiting for a judgement call.” A lot of the time he feels that there is this silent understanding between doctors and patients.
Dr. Luchangco explained to me that the other difference in the ER these days is the bottleneck of patients that get stuck waiting for a room. Most, if not all, hospitals have expanded their capacity of isolation rooms due to the dramatic increase in patients. A great number of those admitted end up waiting two to three days for vacant rooms in the hospital and end up being taken care of in the ER until then.
Anxiety is definitely higher, not just for doctors but for their families too. In fact, many frontliners choose to not go home in order to protect their family. “The fact that we can be infected, and even unknowingly carry the virus to our families – that is what gets us more anxious and scared than usual. We cannot do the same things we did before,” says Dr. Gawaran. All doctors reporting for duty self-impose a strict quarantine for themselves when they get home, if they do go home. “Every day, we wake up not knowing if it gets better or worse, but we still drink our coffee, go to work, try to save lives, heal more patients, and pray that we do not get sick in the process,” he shared earnestly.
A pertinent point Dr. Luchangco wants to drive home, is that hospitals are not the frontlines. “If people end up in the hospital, that means they already have moderate to severe symptoms. We cannot win this fight in the hospitals. To get to the end of this, we need to decrease the number of new cases. It is a simple numbers game.” He emphasised that their fear is justified by a very real danger. “It is in the face of this uncertainty that we can see the separation of those who respond to the call and step up into harms way and those who step back and exclude themselves," he said. There are many health workers who refuse to be pulled off the roster (due to age or comorbidities), and continue to serve their duties, putting their Hippocratic oath before their own safety.
In order to protect themselves, Dr. Gawaran explained that they have to wear uncomfortable Personal Protective Equipment (PPEs) like N95 masks, double gloves, and face shields. “When you wear a N95 mask properly, you almost cannot breathe. We have to wear it for around 12 hours, every day,” says Dr. Gawaran. “We have to properly remove, or doff, our PPEs to make sure we will not contaminate ourselves upon removal,” he adds.
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“I always have to remind myself to never let my guard down and make sure I don’t tire of the tedious infection control measures,” Dr. Luchangco mentioned. To have your mind running at full capacity, on high-alert, with copious levels of stress pulsating through your system, is grueling to say the least. He continued on emotionally, telling me that during their shifts and while they don their PPEs, that the gear serves as a constant and blatant reminder of the pandemic. “Going to the bathroom is dangerous. Eating is dangerous. All these activities require us to compromise our protection by removing our PPEs. Some people will go through an entire shift without doing these things, trying to consolidate them all into a single break. The enemy is invisible, and in my work environment, I know that it could be anywhere, and probably, everywhere,” Dr. Luchangco emphasised.
There is this solemn eerie hum that fills the air, like everybody’s waiting for a judgement call.
— Dr. Austine Gawaran
Dr. Gawaran, in full agreement, says that he cannot afford to be complacent – it may cost him his life. “One thing is for sure, the virus is relentless, undiscriminating, and at times unforgiving,” he tells me. The pressure this virus has put on the country is more than burdensome. He shared his inner frustrations stemming from our lack of testing kits, medical supplies and organisation from the government and its institutions.
However, Dr. Luchangco was actually pleasantly surprised saying: “there are stories all over the world of people frustrated or angry at the government, or healthcare systems, but the truth is... there isn’t a single country or group that was completely prepared for this.” He noticed that there was more organisation, coordination, thinking out of the box, and breaking down barriers than he had ever seen before, more than he had even thought possible for the Philippines. “While some may say it was still too late and too slow, I would have to say that it was faster and more decisive than usual, at both the national local government levels. Unfortunately, this 'better-than-usual performance' is coming from a baseline of an already hugely inadequate national healthcare system,” Dr. Luchangco expounded.
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When asked why and how these doctors are able to be at the frontlines and act so selflessly, Dr. Gawaran—as someone just beginning his life as a physician—said, “Medicine is my calling; public health is my vocation. But my motivations are also selfish. I want to be on the front lines because I want to keep my family, my loved ones, my friends and colleagues safe.”
The enemy is invisible, and in my work environment, I know that it could be anywhere, and probably, everywhere
— Dr. Dan Luchangco
From a man more seasoned, we hear a different response, one that is less animated and more pragmatic. Dr. Luchangco speaks with a thick layer of modesty or perhaps from the lens of routine hardwired into his being. This doctor says that he doesn’t know if he would call himself a hero, or even use the word brave to describe himself as he is just doing his job.
“I didn’t choose to be in the position of confronting COVID-19. I don’t know if I would have chosen it if I were given the chance. I didn't rush to the frontlines when the disease started hitting us. I work in the ER, so I was already there. Maybe the only choice I did make each day was to stay at my post, even as the job got harder. Maybe I don’t know any other way of being,” he comments, sounding unaware of the fact that he is without a doubt, a modern day hero.
Dr. Luchangco opened up further and said that on a personal level he will have to find a way to push himself—through the long shifts, through the experience of having a hard time breathing and moving through the layers of protection. In his own home, he limits contact with his family, undergoes rigorous procedures to keep clean. Dr. Luchangco even has separate pens, charging cables, and other basic things for inside the hospital and out. “I am afraid of slipping up and compromising my safety and that of my family, but I am also getting weary wondering how long it will have to go on like this. It looks to me that we will not get back to our normal lives for several months,” he confesses.
At the end of a grueling day, Dr. Gawaran says that a great night's rest and a hearty meal can do wonders. To get his mind out of pure work mode, he unwinds by talking to loved ones and by trying to work in some home-exercises with dumbbells. Kicking his feet up and watching some comforting Netflix shows gives him a good chuckle at the end of a brutal day. This resident says a small prayer at the end of each and every day, asking for hope and energy for the day ahead, thinking: “when everything fails, hope is one thing that will help us all survive.”
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