SINGAPORE - One healthcare worker came into contact with an infected patient from abroad before Covid-19 got its name.
Another had to tell a patient’s widow why she could not grieve next to his body.
All of them had no idea Covid-19 would be here to stay.
These stories by staff from Singapore General Hospital (SGH) are profoundly told in its book, Purpose With Passion: Our Covid-19 Stories, that was launched on April 24.
The following are the edited accounts of five workers taken from the book, which can be accessed in instalments online at this link.
Internal medicine resident Samuel Koh
"Hi doctor, there is a patient for admission."
As a medical officer on night float - the practice of returning for night duty on one's day off - we probably hear this at least 15 times a night. Little did I know that this was going to be my first contact with a patient harbouring the novel virus.
When I walked in to see the patient, he was coughing vigorously. I reviewed the epidemiological history and found out that he was from Wuhan.
"Did you go to the seafood market?" I asked instinctively, as the infamous seafood market was already synonymous with the virus. He denied initially but continued shortly after I probed a second time: "Actually, I visited the market with my son about three weeks ago."
The silence that ensued was deafening. Between the patient and myself, I suppose, we both had a gut feeling of what that meant.
There was plenty to do after that. Taking his swabs, keying in my findings, calling the infectious diseases consultant on call, and notifying the Ministry of Health (MOH) - all of which had to be done within one hour of his admission.
The patient's son was outside, gesticulating frantically and coughing - without a mask! He was eager to find out when the swab result would be ready. I handed him a mask and recalled asking, or probably berating, him to go to the emergency department. It was adrenaline that kept me going through the rest of the shift.
At the back of my mind, the uncertainty of the whole situation remained perturbing.
The next day, at about 9pm, while I was again busy in ward 68, my phone buzzed incessantly. After I de-gowned, I saw many messages of support, with some directing me to check my e-mail. It felt almost surreal the moment I read the memo that the patient I had seen yesterday tested positive for the Wuhan virus. From that point on, there was no letting up.
After my week of night float, the whole of ward 68 was full; uncertainty became the new normal.
Internal medicine resident Tan Sye Nee
The moment I touched down at Changi Airport on day three of Chinese New Year, I got a call from my senior asking for volunteers at the isolation ward. I had been home in Malaysia for the holidays. Before leaving home, I had reassured my mum: "Don't worry, I'm in haematology. I'm very safe."
In movies, people would want to be the hero and would readily volunteer their services. But when I was asked whether I would risk my life to do this, knowing there was no cure if infected, I hesitated. "Should I even do this?" I asked myself.
Then I thought, since I was living alone in Singapore, even if I got infected, there is less risk to others. Many of my medical officer friends were married or living with their parents.
Initially, I did not want to tell my mum because she had been really worried as my brother had just gone to China to be with his wife. I didn't want to add to her worries.
But if I didn't tell her, I wouldn't be able to make up my mind to step up. I eventually called her, and she understood and agreed with my decision.
Medical and nursing staff at work in an isolation ward at Singapore General Hospital, in November 2021. ST PHOTO: LIM YAOHUI
When I joined the team in the isolation ward, I wasn't very sure whether or not I would be safe, but the infectious diseases department and our seniors really took great care of us. The senior consultants would check in with us every single day, to ask how we were doing. When we had to use the full personal protective equipment (PPE), they took great care to ensure that all our steps were correct.
After managing the first few imported cases, we thought the worst was over. We were then shocked to diagnose the illness in a local who had not travelled and who did not have a clear history of contact with a known case.
Fortunately, our seniors had been very protective and made us wear the full set of PPE throughout. Honestly, we had thought they were over-reacting, being kiasu.
But in the light of the newly confirmed patient, who we had thought was of really low risk, we finally understood why they were so cautious. That gave me the assurance that we were working in a safe and well-protected environment.
Senior consultant Tan Ban Hock
Evaluating a febrile cancer patient is bread and butter for an infectious diseases physician, but when I started typing, I froze.
I had interviewed and examined him mechanically, but as I entertained the diagnostic possibilities, I started trembling. A few days earlier, we had just confirmed Singapore's first case of infection with the virus from Wuhan. Unsurprisingly, it was a tourist from the city.
The patient I had just seen had certainly not travelled, but what if he had, just before his admission, hosted friends or relatives from China? What if he had a family member who worked in the travel industry? I had to ask him more questions.
But he was breathless and coughing. Was this the Wuhan pneumonia? I looked at the cancer patients in the room and all my hairs stood on end. I saw visions of SGH being castigated in the media for spreading the infection to a roomful of cancer patients.
After collecting myself, I made my clinical recommendations on the computer and headed to the next patient on my list. I told myself that none of us in SGH had done wrong - the patient did not fulfil MOH's criteria for a suspect case. Although we had not broken any rules, my mind was racing with all the what ifs.
I told myself SGH would not experience intra-ward transmission. All patients with symptoms that were even vaguely suggestive of this novel infection had to be segregated till proven otherwise.
Fortuitously, I bumped into (Dr Loo Chian Min, the chairman of SGH's Division of Medicine and senior consultant in the Department of Respiratory and Critical Care Medicine) and voiced my concerns.
He understood immediately. We discussed various ways of minimising the risk of contagion. A ward for patients with respiratory complaints would be a perfect solution. By luck, I also met (Dr Phua Ghee Chee, the head of the Department of Respiratory and Critical Care Medicine), and was also able to sell my ideas to him.
If a ward could be found, he was happy to have his staff man the ward.
Medical staff transfer a patient who has recovered from Covid-19 from the isolation ward to a normal medical intensive care unit, at Singapore General Hospital, in November 2021. ST FILE PHOTO
We called them acute respiratory infection (ARI) wards. We made the rules as we went along. In that electrifying early period, every day, (Dr Phua) and I met the consultants running the first three ARI wards and discussed all suspicious cases.
We were determined not to miss any case of the novel coronavirus infection. We read the daily MOH press releases no matter what time they came out. We picked out the workplaces of the day's confirmed cases. These were relayed through text messages to the ARI staff.
Every new cluster site mentioned was incorporated into the electronic medical record system so that front-line doctors would not miss these out in the contact history.
The first consultants of the ARI wards... were true heroes. They worked uncomplainingly in areas that did not have the usual safety nets of a purpose-built isolation ward.
Senior staff nurse Lee Shu Zhen
It was tough to listen in on their parting words. I was fully gowned up - there was no way for me to wipe my tears. I tried to distract myself with the tasks in the room. To hear but not to listen.
The patient was struggling to stay alive, the numbers on the monitors were blinking red, and the loved ones could only view through glass doors. There was a phrase, I thought - ah, "so near yet so far". What should have been a final loving touch was reduced to an intercom encouragement: "Stay strong, fight on."
I was told to do three video calls for my patient, one with each of his children. I had to be in the room, listening to their conversations. As the nurse, I had to do it. The call of duty. Each conversation was supposed to last 15 minutes. I had to do it three times.
And then the ECG flatlined. What do you tell the children? But somehow they knew.
The patient's wife arrived at the ward to see him. A scene that burned into my heart. A pair of lovebirds separated by the anteroom. She pleaded to let her enter the room, to at least be inside the anteroom. We declined. I explained why but those words - those were stabbing words.
It felt morally wrong to let an elder beg to see her love for the very last time, to exchange a final touch. But the stakes were too high. We had an obligation to the nation. It was for a greater good but at the expense of their grief. Protecting our people took precedence over their grief. An obligation we had to uphold, whether it was morally right or not.
All I could do was apologise. The word "sorry" could never describe the guilt I felt and could never fill the void in their grieving hearts.
With the medical social worker nodding his assent, I offered a final video call, to bridge this physical gap between the two doors. Maybe the family could have closure.
The patient's wife finally broke down and acknowledged his death, while I stood in the patient's room, holding the phone as close to his face as possible. Guilt ate into me but it had to be done this way. Do no harm.
Beneficence to our people. This was the call of duty.
A senior staff nurse takes an electrocardiogram, or ECG, for a Covid-19 patient, at Singapore General Hospital, in November 2021. ST PHOTO: LIM YAOHUI
Consultant Lim Chin Siah
At that time, we thought it was a one-off thing for the migrant workers. We knew it was going to be a large number but didn't know how it would unfold. The largest number swabbed at a single time then was just a few hundred.
That Easter Sunday morning, while walking to the Redhill site, I saw cranes lifting mattresses through the windows of the empty Housing Board flats. These workers had been relocated at short notice.
There was apprehension all around. The Singapore Armed Forces (SAF) had set up a tent for us. They were registering the workers for us, getting them ready to be tested.
All we had to do was swab and label the specimens, and send them off to the lab. It was a colossal operation, and the choke point was at registration, which was done manually. Each swab took just a few minutes.
After the swab, there were again long queues, this time to collect care packs containing SIM cards. So, the SAF had to deploy manpower over there too - they were running all over the place.
Thanks to the National Dental Centre Singapore, 40 dentists and nurses came to our aid, and we managed more than 1,500 swabs over six hours that day. That record became the benchmark.
In the midst of the sweltering heat as the swabbers worked outdoors in full PPE - disposable gowns, gloves, N95 masks and goggles - SGH and SingHealth leaders turned up offering support, including a surprise bubble tea treat.
Chief executive officer Kenneth Kwek gave me $500 cash to buy drinks. After paying for them, I had a few hundred dollars left.
"How do I return this to CEO?" I wondered, naively thinking that the swabbing was going to last only a few days.