Ahmed Zaki, MD is an Internal Medicine specialist based out of London, Ontario, a city in the east coast of Canada. Internal medicine is the study of prevention, diagnosis, and treatment of internal diseases, so he deals directly with coronavirus patients. He even had to get tested for the virus when he started showing symptoms. He also happens to be my younger brother.
This Dubai kid has gone through 8 years of university and 2 years of specialisation to get to a point today where he can save people. Now he is living and working as a senior resident at an academic tertiary care hospital in London, Ontario.
Gulf News spoke with Ahmed to get an inside look at a day in his life as a doctor who treats coronavirus patients.
4.30am: Check my temperature
Most days, I am up at 4.30am and at the hospital by 6.30am. The first thing I do when I wake up is take my temperature. All hospital staff usually do that. Then I log onto my computer and read the charts of new patients that were admitted to my team overnight. I read about what’s wrong with them, what’s been done and then I’ll make a note of what other questions I have, exams I want to do, or tests I want to order before I leave my house.
I’ll also review the bloodwork of all the current patients on my team to make sure things are moving in the right direction. Most of them are not coronavirus patients, but we have to test the ones with symptoms. The emergency room will usually conduct that test on anyone they suspect has the virus, which lately seems to be everyone because of all the different symptoms COVID-19 patients can present with. We’re lucky here, because test results are usually available in 24 hours, while it can take several days at other hospitals.
6am: Suddenly everyone is a runner
I commute to the hospital. It takes me about 10 minutes to get to work. I usually listen to the radio for news updates. The streets are pretty empty. But there’s a lot of people jogging on sidewalks. Suddenly, everyone started to become a runner, even though it’s still pretty cold here. It’s usually anywhere between -2 and 10 degrees Celsius, mostly hovering at around 0 degrees.
6:15am: Screening
I arrive at the hospital and the first thing I do is go through our daily morning screening. All hospital employees get screened and everyone gets asked the usual questions. “Have you travelled recently? Have you had contact with COVID-19 patients? Do you have a runny nose? Do you have any body aches?" Etc.
Then I head inside to have a quick breakfast in my office. I usually eat a banana, an apple and a clementine along with a protein shake. Some doctors at the hospital choose to have a big breakfast at home and then they put their mask on, keep it on all day and won’t eat until they get home at the end of the day. When they are working, they don’t want to touch their mask to take it off and risk contamination.
My shift usually lasts 10 to 12 hours. I start at 6.30am and finish at around 5pm. But sometimes I stay later. Some days I have a 27 hour shift. That is usually when I am on call. So I end up staying from 6.30am to 10.30am the next day. We don’t have any set break times.
Sometimes I get lucky and it’s a slow day and I can take a quick 30 minute nap, but even then it’s hard to really rest because you know at any moment a nurse, junior resident or another doctor can call you or a code blue happens and you have to run it. To be honest though, you get pretty used to it.
6.30am: Mask fitting
My shift officially starts with a medical mask fitting. I sign out 2 masks from the charge nurse. One is an N95 to prevent airborne particles, especially coronavirus during this time, and the other is a face shield to protect my eyes and prevent droplets from getting on the N95. What a lot of people don’t know is that N95s need to be fitted for your face. There are many models of N95s and the process of fitting your mask is something all healthcare workers go through before they know which model will protect them.
It takes about 30 minutes to get fitted and involves you wearing a hood and someone spraying chemicals around your face. If I can smell it, then I know the mask is not fitted properly and I either need to adjust it or use a different model.
I start by sanitizing my hands, then I put my masks on. This is the only time I actually touch the mask to adjust it on the bridge of my nose. Throughout the day, I never touch the mask. I use the string on the back of my head to take the mask off. Once I’ve taken the mask off, I only ever touch the strings of the mask to put it back on. During lunch, a lot of doctors and nurses store the masks in Tupperware to keep it safe.
Between 6.30am and 8am, I continue to review my patients’ bloodwork, assign which residents to see which patients, and go lay eyes on patients that will be potentially discharged during the day.
8am: A meeting
I meet with the resident who was on overnight shift and the rest of the team. I’ll usually do a teaching session on either an approach to diagnosing a medical condition, how to treat a patient or an interesting case I saw.
Since I am a senior resident, I have to see all the patients that my team are treating. There are four corona patients on my team in addition to 15 other patients. As an internist, I see a wide range of medical conditions ranging from patients who have heart failure, kidney injuries, pancreatitis, and even ALS. We limit the amount of doctors that have contact with coronavirus patients. So it’s just me and another doctor who deal with the COVID-19 patients.
The problem with COVID-19 is that it is contagious and there is no definitive treatment for the virus yet, although there is a lot of research happening all over the world. All we can do at this point is treat the symptoms and provide support. We treat a fever with acetaminophen. If someone has shortness of breath, we give them oxygen, usually through nasal prongs. Those are the transparent tubes that sit on your upper lip and are inserted into each nostril.
However, if someone isn’t getting enough oxygen with the nasal prongs, sometimes the only option is to intubate them and put them on a ventilator. It seems that compared to other respiratory conditions like the common cold or the flu, patients who get COVID-19 are more likely to require a ventilator in order to survive. This is one of the reasons why governments all over the world are asking people to stay home, because many hospitals do not have enough ventilators if too many people got sick at the same time.
Some patients refuse to be put on ventilators because it is not within their wishes or goals of care. That’s perfectly fine and we will always respect their wishes. In those cases we would do whatever we can to help them get better with the nasal prongs, but if they continued to worsen we would then try and make them feel as comfortable as possible, as they die.
The decision whether or not to be intubated and be put on a ventilator is a very personal one. It is a conversation that patients should have with their doctors and takes into account other medical conditions that patients have, their current situation and functional status, and their wishes.
12pm: Lunch
I usually grab a quick sandwich for lunch or a chicken teriyaki bowl. I am lucky enough to work in a hospital that gives internists lunch for free. Some doctors won’t eat or drink anything at the hospital because they don’t want to take off their masks and accidentally contaminate themselves. I know that a few nurses and doctors have contracted the virus, but I don’t know about how they are doing due to obvious privacy reasons.
At the moment, hospitals around the country have a shortage of personal protective equipment, so we are all asked to re-use them whenever possible which is why we are extra careful when we want to take them off or put them on. Otherwise, when it comes to bed space and ventilators, I think we are currently okay, but I am also not working in the ICU, so I don’t have the exact details of what the current situation is like there. In the city that I am living in, people are doing a great job at self-isolation. We haven’t been hit by a wave of COVID-19 patients that other cities have seen. I’m hoping that doesn’t happen here.
12.15pm: Probable and confirmed cases
After I’ve seen all my non-coronavirus patients, I see my probable COVID-19 and then my confirmed COVID-19 patients. That way, I don’t inadvertently transfer the virus to patients that don’t have it. Everyone is afraid of catching the virus. But at the same time, you have to show up and go to work. The junior residents don’t see the COVID-19 patients, because they would need to be seen by myself or the consultant anyway, so there is no point in exposing them too.
Most of the COVID-19 cases in our hospital are not fatal. While some need just a bit of oxygen, the more serious cases are on ventilators and they are the ones who are at a highest risk of dying. Some studies suggest the virus seems to have a higher case fatality rate in men,, elderly, and those with previous heart and lung disease.
3pm: Wrapping up
We are getting close to the end of the day, so I use this time to wrap up and update my patient notes. I meet again with the rest of the team and we discuss what we’ve done today, handover any issues that need to be followed up on to the resident who will be on call overnight, and if we have time, do some teaching before people start to head out.
I would say that there are definitely less sick people in the hospital these days, especially since a lot of them are staying indoors. There are less workplace accidents, less regular influenza, because they just don’t get exposed to germs as much. All elective surgeries have also been postponed. Despite that, it still feels like work is just as busy, if not busier. This is partly because a lot of other doctors have been calling in sick or are asked to stay home even if they have mild symptoms. We don’t have medical students to help out with seeing patients and cover overnight shifts. Usually, medical students would make up half the team in an academic center like ours.
A few days ago I developed some coronavirus symptoms, including runny nose, sore throat, cough and body aces. I was feeling really sick and had to stay home until I got tested. The coronavirus test was painful. They take a swab and push it deep into your nose, and it kind of feels like a needle.
I was coughing and tearing up. It’s pretty uncomfortable but thankfully it went by really quickly. Luckily the test came back negative for the virus, but it’s not perfect so some people need to be tested again depending on their symptoms. Some patients, who have done it once, don’t want to do it again because it is really uncomfortable. Took about 30 minutes for my nose to feel normal again.
I also had a blood test done.
5.30pm: Prepping to leave
I have a pretty specific routine for when I leave the hospital for the day. First of all, I take off the scrubs that I was wearing all day, and change into a new pair of scrubs. Then I head to the scrub machine and exchange my old pair for new pair of scrubs to take home. Those are the sealed and clean ones that I can wear tomorrow morning. I do this, so I don’t take the virus out in to the world with me.
Then I head home, take off the scrubs I just put on, and place them in a bag to exchange the next day. I take a shower and put my home clothes on.
In one day I go through at least two scrubs. More if something spills on my clothes and I need to change, but that doesn’t happen frequently, especially now because of the gowns we need to wear when seeing patients.
Many changes have happened in the hospital during this pandemic, for example everyone is being screened as they come in our hospital. There is no large in-person teaching groups or grand rounds, which was huge for us, since we are an academic hospital.
Every morning I would usually teach residents and medical students too, but they were removed from the hospital and have been asked to stay home even though many of them would’ve wanted to help out. We don’t eat lunch together anymore. We re-use our personal protective equipment and avoid touching anything unless it’s absolutely necessary. Stress levels are high, but I think morale on my team is still high, which I am happy about.
We also try to assign workstations to everyone, so people don’t share them anymore. Visitors are no longer allowed to come to the hospital except if a patient is imminently dying in which case only 1 visitor is allowed. If the patient is dying of COVID-19 unfortunately no one is allowed to visit them because it means there is a risk the virus can be spread back out into the community.
6.30pm: Dinner
I make dinner with my best friend, who also happens to be my house mate and we relax. Some days I’ll do a quick workout at home to maintain my dad bod, otherwise I’ll just read a book.
8pm: Prep for the next day
I hop back on my computer, read about any updates on COVID-19 and prepare a teaching session for the next day.
10pm to 11pm: Review and sleep
I’ll review my patients’ bloodwork again and update our handover list, which is how we communicate and then go to sleep. I fall asleep as soon as my head hits the pillow.
