It’s been a busy last few months. More than that, let me explain: busy, hopeless, fulfilling, heart-wrenching, courageous, painful, satisfying, nauseating, and blessed. All these emotions recently, and sometimes all at once. Quite overwhelming.
Four months ago, I flew back from India, after shopping till I dropped, for my July 4th wedding. 48 hours after I came back from sipping lassi in Mumbai, I was back at work and there were whispers of a new virus, COVID something…basically the flu, just a bit more contagious. I wasn’t too concerned really, crazy things like virus outbreaks don’t happen in America anyway, right? Ebola happened in Africa, SARS in China, this type of stuff wouldn’t get bad in America, and definitely not in New York!
I was in for a surprise. No, more a shock. It was around 9:00 a.m., two hours into my shift, when I got my first notification of the day: EMS called into the Emergency Room (ER) ahead of time to give us a heads-up because they were bringing in a really sick patient. “We have a 59-year-old male with an oxygen saturation of 68.” That’s impossible, I thought to myself; 68% oxygen correlates to practically dead; with such little oxygen in the blood and to the brain, it definitely means they are not sitting upright or speaking.
But on that morning in early March, a well-dressed 59-year-old patient was sitting upright, awake, alert, speaking in full sentences, huffing and puffing a bit but able to tell me he didn’t have any medical problems and was totally fine yesterday, and that all of a sudden last night, he felt he couldn’t breathe.
The patient had never been to the hospital before and only called EMS about 12 hours after his symptoms started. They gave him oxygen en-route and we gave him even higher concentrations in the ER, but he was getting more and more tired. Could this be it? This new virus we know nothing about? Within 20 minutes of getting to the ER, my patient could no longer breathe for himself—I had to induce him into a chemical coma, put a breathing tube down his throat, and put him on a ventilator. This is not the flu, I realized very quickly.
I went home, and for the first time since my internship, I cried and cried. This disease is serious, it’s in New York, and it’s nothing like we’ve ever seen before. I tried everything I have learned and I still had to intubate this otherwise healthy, awake, and speaking young man. And to top it off, I had dinner plans with some friends that evening and they canceled on me: “You’re an ER doctor, I really don’t want to get this virus. Let’s reschedule.” Ouch, dagger to the heart. And when I needed them the most.
I returned to work the next day, and I looked up my patient in the electronic medical records to see how he was doing. Hopefully, he had turned the corner. Instead, I found a death note. I stopped. It felt like the whole world stopped. If I wasn’t in public, I might have cried again.
Over the next few days and weeks, this heart-wrenching story repeated itself over and over again. There was just so much death. Four, five, six people died a day. And with the strict “No Visitors” policy, we adapted to protect family members from exposure to COVID, so our patients were dying alone, with no one to hold their hand, say goodbye or recite a prayer over them. I started giving my own phone to my patients to Facetime their family because I knew it was very likely the last time they might talk to each other. Then, their family members would text me every day to get an update, and I was just hoping I wouldn’t have to be the one to tell them if their family member had passed away.
But for every few people that did die, there were a lot of patients who were given an enormous amount of oxygen too and saved their lives. There were many people who came to the ER in pain or coughing, with trouble breathing, or vomiting, who we could prescribe medications to, and we really helped them get better and enabled them to walk out of the ER in much less distress.
There were so many patients so afraid, asking, “am I going to die?” And I could assure them that since their oxygen was normal, and their trouble breathing was mild, they were going to have a really rough few weeks but they were going to be okay. This is what I signed up for—to help people. And in the first and hopefully the only pandemic in our lifetime, I am able to help people. I used to hear stories about my grandfather, the only Muslim doctor in Junagadh, Gujarat, who used to ride his bicycle in the middle of the night during monsoons to make house calls, and I wanted to be just like him.
I traveled to Pakistan, Haiti, and Nepal, after earthquakes, and I did TKN in Dar es Salaam for two years, because I am obsessed with the rush I get from helping people. And now, while I don’t wish this pandemic or an earthquake on anyone, I am so fulfilled that I can help people.
And I could give them hope and faith. I must admit, I didn’t think of this myself, It took a nudge from a non-medical friend of mine to make me realize what I had the opportunity, and obligation to do. In this time, when people were afraid for their lives, my job was not only to order lab chest x-rays and administer oxygen, but also to give them hope, faith, and courage. I had learned in my career to keep faith and religion out of the practice of medicine. But I threw that lesson out of the door. I told people to pray, I took their hand, and I prayed with them. I told them they were going to be fine, and that they had to have faith—that they were going to be okay too; that any God they believed in was going to protect them, and that I would ask my God to protect them. I have never felt closer to my faith than I have in the last two months.
And my faith came to me in all forms. Good friends of mine, Rozina and Adeel Jivraj ordered dinner for my entire ER during a shift I was working, which led to a cascade of other Ismailis, Zak Karim, Rasul Sharif, and even my entire high school class, chipping in to buy dinner for the staff. Another Ismaili, Shezleen Vellani-Nensi has started a GoFundMe to “Applaud the Squad,” and she continues to send lunches and dinner to our ER and planned a surprise Mother's day event for my entire hospital!
Covid-19 has also brought together the four Ismaili doctors and a physician assistant at my hospital, Samreen Kwaja, Sara Huda both third-year Internal medicine residents, and Riyaz Ali, a 25-year-old Physician’s Assistant working with me in the ER. We have a WhatsApp chat to check in on each other, let each other know when the aforementioned free food is coming in, and also to rotate checking up on Ismaili patients, who we consider to be our own family.
After six weeks of lots of highs and lows, lots of intubations, and lots of free food and bonding over frustrations and hardships with my coworkers, I was at work on a Sunday afternoon and found myself extremely fatigued. A physician’s assistant was telling me about a patient he was worried about, and I couldn’t keep my eyes open. Something was wrong with me. I spoke with the other doctor who was working and told him I think I need to go home, I didn’t feel well.
The other doctor panicked that he would be all alone to see patients, and out of guilt, I decided to stay a few more hours. I was off for the next two days and was very sluggish, but hey, I’m an ER doctor in the middle of a pandemic, I’m allowed to be tired, right? Tuesday night, I felt hot and so my mother insisted I check my temperature. And we all know Ismaili mothers: when they tell you to do something, you do it. I was too tired to go to the kitchen to get the thermometer, but she asked me to do it, so it was going to be done.
100.3 degrees Fahrenheit. I took two Tylenol pills and I couldn’t sleep a wink. I wrote a long Facebook post that night about the importance of sheltering-in-place and quarantining. In my mind I was still a doctor, preaching about public health measures, to try to flatten the curve so I wouldn’t have to intubate so many patients when I went to work later that week.
I finally fell asleep, and I awoke at 5 a.m. came, realizing that I was no longer a doctor; I was the patient. I had uncontrollable chills, severe pain, initially in my mid-back/lower lungs, and then all over my body. I vomited and vomited. I was weak. My father had been asking over the course of the last few weeks if he could come to bring me food or anything to help me get through my busy work weeks. I kept thanking him and declining his offer as I knew he was just making an excuse to get out of the house. But after 48 hours of severe pain and endless nausea, I asked him to bring the Percocet I had leftover from my last knee surgery. My diet for the next week? Percocet, Zofran, Gatorade, chicken soup, and ice cream sandwiches.
So many people called and messaged, and only sometimes I was strong enough to look over at my phone to see who was calling, and smile in appreciation for their thoughts and prayers. I would get my strength back intermittently, and try to respond to some before dozing back to sleep. On day 12, the pain, and nausea finally subsided, and so I decided, the tough girl that I think I am, that I was healed! I started scrubbing down my bedroom and burning incense to rid my house of this nasty bug. My too-smart-for-her-own good-mother told me to take it easy, but what does she know, right? I'm fine! Then just as I was about to go to bed, I felt lightheaded, weak, and the fatigue and back pain settled all over again. Day 13 and 14 were a wash, I slept all day, only to wake up to take a Tylenol or Percocet for my headache and backaches, sip on my liter of Gatorade and go back to bed.
Then on Day 16, I got an invitation for an “AFRICA CDC Zoom session: Speaker Dr. Fazila Lalani.” Oh my God, I totally forgot I had accepted a speaking engagement before I became ill. My fiancé sat in the living room with a mask on and created a PowerPoint for me from the COVID manual I was writing for the Aga Khan Health Services, Tanzania. Besides all the medical mumbo-jumbo on how to intubate and who to discharge etc, I think the best part of my talk was the extremely detailed instructions on how to quarantine, as I now had first-hand knowledge.
My boss has been checking in on me daily, and actually took two of my shifts that I was scheduled for last week. So, after being off for three weeks, I’m back at work helping my patients. Also, I’ve been missing out on all the yummy dinners Shezleen has been sending to the ER! I was getting better and had the last week off so I expanded my 15-minute talk to a one-hour talk and presented it to AKHS Global. I repeated the talk the day after, and this time the Zoom session was at capacity of 100 participants, so someone from Kenyatta Hospital in Nairobi emailed me requesting I repeat the lecture on their hospital's 1,000 person Zoom platform.
It was a busy whirlwind of 60 days. I feel blessed that my father pushed me to continue medical school when I wanted to quit 100 times. I feel blessed that I have been able to help during the pandemic of the century, both for patients here, and hopefully doctors and nurses abroad. I feel blessed that my priorities in life have completely changed and having a huge wedding just doesn’t seem important anymore. I feel blessed that I had COVID because, as Jack Ma from Alibaba group has said, "For people in 2020, if you can stay alive, you have made a profit already."
Having experienced this virus, I have to emphasise that it is deadly. Please do not underestimate its lethal nature that spares neither young nor old, rich nor poor, doctors nor the healthy. Physical distancing and health precautions are essential, and maybe so for a long time. This is the new normal. We just have to get used to it. But we can all help by not adding to the strain at hospitals by minimizing our nonessential trips and errands, and by keeping ourselves safe.
We care for you.
Dr. Fazila Lalani is a board-certified emergency medicine physician, affiliated with Long Island Jewish Medical Center, New York.