Shamabi

Prologue – Diabetic Ketoacidosis & Uremic Encephalopathy in COVID

You came to us with a tube deep inside your throat, your eyes completely closed. You were not talking, not moving a bit and not even feeling any pain. In fact you were in coma. You were a sugar patient and your body had levels well above 500. It was such in excess amount that it was poisoning your body. It was making acid inside your body which was affecting your organs especially the brain which has put you in deep slumber. Then to make things worse, it had silently affected your kidneys like termites destroying the wood and we came to know your creatinine was 10x the normal levels and kidneys had stopped working, further adding to the ongoing insult to your brain.

COVID – The Cytokine Storm

So what triggered all this? What was it that landed you in this trouble? Yes, as expected it was COVID. It started the mayhem inside your body which we call – the cytokine storm. It turned your body into a battlefield where your immune system with all its might was trying to stop the carnage going inside your body. The silver lining was that It had moderately affected your lungs which meant you still had a fair chance to win this battle.

The response

We started cleaning your blood first by removing excess glucose with insulin. Then attempted to clear excess potassium by sending it back inside your cells. We tried to clear excess toxins by dialysing you. But your body was still overwhelmed. You did not respond. You didn’t even acknowledge the severe repeated painful stimulus we gave you. We were disappointed. You were only 47 with two daughters at home and a husband who too is battling COVID in a nearby room. But we were still hopeful. In all the despair, the hope is all we always have. We dialysed you again. You acknowledged this time by moving your head. You even moved your eyes. You raised our hopes but just to shatter them again.

The most dreaded thing had happened. You started running fever which basically meant your body was now attacked by another bug. You were in sepsis. The infection was fast spreading. Your BP was still under control. You were not requiring any drugs to maintain your BP. We doubled down our efforts. We tried to cover all the possible bugs with antibiotics – Gram positive, gram negative, pseudomonas, MRSA, VRSA, anaerobes, et al. But your fever did not subside. Your blood or urine reports did not give any clue. You were slipping away.

The Waterloo moment had come!

Your blood had slowly started moving out of your blood vessels due to the underlying infection. Your BP had started to fall. The fever was not going away. We tried to prevent falling BP and control infection by adding new drugs, but it was all futile. Your body had started swelling as blood was moving into the body tissues. We again tried to dialyse you but this time you didn’t let this happen as your blood pressure was not enough to tolerate the procedure. We had added two Vasopressors to increase your blood pressure as you were losing fluid at a much faster rate.

Fait accompli

But then your fever had subsided. Had we turned the tide? No, we hadn’t. Your body was doing triage and had started shutting down blood to non essential parts to preserve adequate pressure to essential parts like brain and heart. There was no pulse palpable in your arms and legs. They were cold like ice. The leaked blood from capillaries was visible on your cold skin. We made a last ditch effort trying to salvage you by pushing more fluids and adding another vasopressor.

Epilogue

Shamabi, I am writing this as you are breathing your last. We controlled your infection but the bug had mortally wounded you. It was a fait accompli for the virus. But you were such a fighter and a wonderful person. You always gave us hope. When I blindly put that catheter deep inside your subclavian vein, you allowed it to pass in the first attempt. When I was putting the same in femoral vein for dialysis, it was again a cake walk despite you being an obese patient. When you moved your head and eyes after the dialysis, I forgot all the exhaustion after those gruelling 4-6 hours standing in PPE beside you pumping you oxygen via bain’s circuit.
But your illness was always a step ahead of us. May be you could have came a little earlier. May be something else could have been done. We were humbled by your illness. But people like you give us a reason to fight.

I am sad, tired and feeling low but believe me I am satisfied that your sugar levels were no longer killing you as I had controlled them, your brain was no more insulted by the unwanted toxins from the kidneys as I was able to dialyse them out and the bug which was causing sepsis was also tamed in the end. Alas by that time, you had decided to say Goodbye. May be this could have happened some time earlier. May be you would have come a bit earlier.

Likewise everyday, 100s of other Shamabis write their own tales of woe by succumbing to this ruthless unsparing deadly COVID monster. For every doctor’s damnedest effort to save that one precious life at their hands but futile at the end, what left behind is the unparalleled pain and trauma haunting their heads- not to express but burry it inside us. Though shattered inside, but still we stand firm finding the ray of hope and life in the perishing and dying. However the truth is “ with each death, a part of us also dies”.