An ER in Kathmandu during the pandemic: a lesson on motivation

By | June 25, 2021

It was 2:00 a.m. I had just finished shifting a severe coronavirus disease (COVID-19) pneumonia/ARDS patient to the intensive care unit (ICU) after he was intubated in the emergency room (ER).

The ER was teeming with patients awaiting admission. For new patients to get a bed, some admitted ones have to be discharged or dead.

Outside the ER, four ambulances arrived — each carrying a COVID-19 patient on oxygen. One ambulance driver came rushing towards the ER and said he had run out of his oxygen supply. The triage nurse dragged an oxygen cylinder and rushed towards the ambulance.

I hurried behind her in a hazmat suit, climbed into each of the ambulances and quickly assessed all four of them. One of the patients, a female in her 50s, was extremely tachypneic, breathing at around 40 breaths per minute and on 15 liters per minute of oxygen via a non-rebreather to maintain an oxygen saturation of 80 percent.

Luckily, the resuscitation room was not occupied as I had just shifted a patient to the ICU. We shifted her to the resuscitation room, and she received endotracheal intubation.

Now came the hard part, finding an ICU bed for her. There was only one mobile ventilator in the ER, and it was occupied.

Our team with the patient’s visitors frantically started calling hospitals in Kathmandu one by one to ask for an ICU bed while managing other cases in the observation area.

At around 7 in the morning, we finally found an ICU bed in another hospital. I gave the physician hand-off to prepare a referral note, and she was ready to be shifted.

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I had two hours left on my shift, and there were patients in the observation yet to find a bed to be admitted — a typical day in a hospital in Kathmandu in the midst of the pandemic.

The nurses arrived for their morning shift. The nurse in charge was cleaning the station desk with alcohol swabs.

‘“Good morning, doctor. How was your shift?” she asked.

“Good Morning, Rejina (name changed). Thank you for keeping us all safe,” I replied.

Lucky for us, none of us got infected during the whole pandemic despite working in the ER and being the first one to come in patient’s contact in one of the busiest emergency departments in Kathmandu.

Along with the PPE, systematic triaging and isolation and negative pressure rooms, I believe it is mindfulness at work that plays a huge role in the protection of health care workers.

The motivation to work for a greater cause — a noble cause that drives us towards perfection, towards mindfulness at work even during the most stressful of circumstances. It would not be completely correct to say the fear of getting infected and working with no margin of error protects us. Actions driven by fear will lead to burnout and fatigue. It prevents us from bringing out the best of our abilities.

The pandemic unites us, the health care workers, even more.

Like soldiers fighting on the battlefield to protect their fellow people, it is the same driving force for both soldiers and health care workers. “A greater cause,” “a noble motive” to save our people.

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Let us continue working selflessly, the way the health profession is meant to be practiced. Let’s continue motivating each other and create a good work environment for our own well-being. Let’s walk towards the path of being the best version of ourselves.

Bijay Phuyal is an emergency physician in Nepal.

Image credit: Shutterstock.com


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