COVID-19 Induced acute Parkinson's disease!

Blog Author(s): Mihir R Gangakhedkar, ERS Member (India) / 5 May, 2020

Disclaimer: A sense of humour and not scientific scrutiny is needed for the following article.

I could hear myself breathing loudly and feel my sweat sticking to me uncomfortably under my scrubs. My body was acutely aware of the discomfort and every signal was towards getting the job done quickly, but no. An external influence just wouldn't let me. "It's been fifteen minutes" I think, but the clock screen seems to suggest just five! Cognitive impairment well on its way I think.

I revise my plan - "Second door to the left", a seemingly simple task. On any average day, no mental calculations of the number of steps or distance within a ward would have come up at all. But today I could feel my mind laboriously go through the visual data to estimate the number of steps, possible hurdles in my path and pausing to allow me to breathe, an entirely different complex act! This was in the first few days of the present pandemic crisis, at our institute. I had been called to perform a thoracentesis for a COVID suspect. None of the previous training sessions on appropriate PPE donning and doffing could actually prepare me for this.

At 1.85 metres I may not be the tallest but I am easily on the taller side of the working pool. The jumpsuit PPE which is available is clearly for someone several inches shorter and the gloves for smaller hands. But with no other choices I "jump" into the suit grumbling to myself. I realize my forehead is exposed and pull the hood further ahead. Alas, it covers my eyes completely, over-riding my forehead altogether! The helpful nursing officer comes up with several pieces of tape, a small triangular piece of a drape and goggles. I wear the drape over my head like a bandana and then the hood comes over, now my forehead has at least the drape on it. "No face-shields yet Sir, sorry". After several tapes at points of tension to avoid a disastrous wardrobe malfunction in the ward, I venture from the donning room. "One small step for a man and a giant leap for mankind".

In times of trouble, my mind has the habit of playing dramatic commentary in the background. The ergonomic disaster that the suit is, it doesn't allow me to lift either foot even a few inches off the ground and a forward movement of no further than half a foot. The restricted length puts me in a persistent kyphotic forward bend. I shuffle my way to the predestined door. I see the young woman, diagnosed to have a lymphoma sitting comfortably in bed. I introduce myself with a voice Bane would be proud of. I inform her that this seemingly clumsy space creature is going to perform a USG guided thoracentesis. She consentswith a slow surveying glance.

As I hobble along to get the machine started, I bend down to connect the power cord and trickles of sweat enter my eyes. "You cannot touch your face!" I hear myself mentally. Squinting through the onslaught I manage to get the device working and after what seems like an hour I am done tapping the young lady and relieving her of a few hundred milliliters of fluid. (The tap in itself could have been a paragraph but I'll save you that description.)

Once the sharps have been taken care of, I take her leave and leave the room shuffling once more. Having entered the ward in PPE I have to see the rest of the cases too. Two stable patients, one dead body waiting to be removed, one patient with an intercostal drain and then the final door. With all the bent walking and head movements due to the sweat, the N95 has just shifted a little lower on my nose bridge and now my vision is misting. Slowly, blindly I walk to the final door.

Pushing it open, I see a middle aged man, sitting erect and looking at the window. On seeing me he smiles happily and walks to two meters in front of me. He must be as tall as me, but him standing erect and me in my PPE there is a clear mismatch. Bane asks "How are we today?" "I am absolutely fine doctor, waiting to get out of this room." I slowly raise my hand to put a congratulatory thumb up, followed by a namaste and with a slow rotatory movement I take his leave. I shuffle my way out to the doffing area. Possibly mildly hypercapnic, I struggle to remember the sequence and finally get the suit off to see myself drenched. It takes me a moment to readjust to the new found mobility and finally I am truly walking.

As I complete my procedure notes for the thoracentesis and the rounds for the rest of the patients, I can't help but think of how the COVID crisis has truly made us confront a new reality. One where we expect the patients to accept treatment from hooded and covered strangers with no insignia to confirm they are doctors.

If trust was something we needed from patients as their treating physicians, now we actually need blind faith! Where your mild patients in quarantine or even in your ward, look several leagues fitter than you in your 'Parkinson's Producing Equipment', your PPE! A reality where even when clinically certain while performing procedures, a complication which can necessitate another painstaking PPE-limited intervention is never truly far away. Where now as non-surgical physicians, we have a real endurance governed aspect to our patient management skills in addition to the mental weight-lifting.

A time where our sweat is actually an objective measure of our efforts while treating patients. And finally, a reality where we live out a science-fiction story and hope that this is not just the beginning of Mother Nature's imagination! **written informed consent was obviously taken.


Blog disclaimer: The opinions expressed in the blogs and comments section do not reflect the opinions of the European Respiratory Society (ERS). ERS is also not responsible for the accuracy of the information provided within.