• A 41-year-old doctor from Tan Tock Seng Hospital talked about his work treating critically ill Covid-19 patients
• One of his patients was Bangladeshi worker Raju Sarker whose first child was born when he was in ICU
• The doctor himself is a father of three and the youngest child is a baby
• Part of his job also involves supporting young doctors’ psychological well-being and bereaved families
• To this day, he continues to take strict precautions such as showering four times a day

SINGAPORE — Caring for a newborn is challenging at any time for a new parent. And when you are also a doctor attending to infectious Covid-19 patients in an intensive care setting, the basic parenting task of holding your baby after work becomes more complicated and stressful.

Just ask Dr Puah Ser Hon, 41, a respiratory physician at Tan Tock Seng Hospital (TTSH) who is a father of three young children.

His youngest son, who is turning one, was born in July last year when Singapore had close to 50,000 confirmed Covid-19 cases.

A consultant at the hospital’s respiratory and critical care medicine department caring for the sickest of Covid-19 patients, Dr Puah is familiar with the stress of juggling work on the frontlines and keeping his family safe in these unpredictable times.

He looks after patients in the intensive care units (ICUs) at TTSH and National Centre for Infectious Diseases (NCID), many of whom require breathing support to deliver life-sustaining oxygen to their lungs and around the body.

Some of these patients spend months with their lives hanging by a thread.

One of Dr Puah’s patients was Bangladeshi migrant worker Raju Sarker, who made news headlines when his wife gave birth to their first child in Bangladesh while he was under intensive care here. Mr Raju spent nearly five months in hospital fighting for his life from February to June last year.

Dr Puah’s work in the hospital also involves managing patients suffering from other respiratory conditions such as chronic obstructive pulmonary disease and chest infections.

As clinical director of TTSH’s respiratory therapist services, he works with the respiratory therapist department and ICU committee to provide ventilator care for patients who are critically ill.

FOUR SHOWERS A DAY

Describing his fears and dilemma over whether to self-isolate himself after learning that his wife was pregnant at the start of the pandemic, Dr Puah said: “With two young kids and one on the way at the time, we were really worried.

“It crossed my mind if I should segregate myself from the family but that would have been tough on them. I still had to be a husband and father to my children.”

Dr Puah said that he went the extra mile to ensure that he did not carry the coronavirus home to the family.

Other than adhering to the strict infection control protocol at work, he took an average of four showers every day — a habit that has remained now a year-and-a-half into the pandemic, although his anxiety has eased after learning more about Sars-Cov-2 virus over time, such as how the disease is transmitted and that there are vaccines that offer protection.

“I’ll shower before work, then again when my shift in the ICU ends and before going home from the hospital. Upon reaching home, I’ll take another shower before physically touching any of my family members,” he said.

A medical student when the severe acute respiratory syndrome (Sars) hit in 2003, Dr Puah knew that he would be placed on the frontlines of disease outbreaks when he chose to go into respiratory and critical care medicine.

“I had hoped never to experience a pandemic but when it did arrive, it wasn’t much of a surprise that (respiratory physicians) would be one of the first people to be involved, given the discipline I’m in.” 

Yet, that acceptance did not dull the feelings of anxiety, fear and uncertainty when he encountered his first Covid-19 patients.

“No one knew what to expect. Rules were enacted, changed and modified based on the most current knowledge we had at the time,” he recalled.

“It wasn’t just clinical practice that had to change, but also how we interacted with people, the medical students and how we conducted administrative work within the hospital.

“At the back of the mind, there was always this anxiety that whoever we were speaking to might pass on the disease to us.”

Even though more than a year has passed and Covid-19 feels like “part and parcel of life” now, Dr Puah said that it is not uncommon for healthcare workers to still experience elevated levels of anxiety.

“We are all getting vaccinated now, but I think there will always be this fear that one day, we may accidentally take the disease home to our family.”

SUPPORTING JUNIOR DOCTORS

As the programme director of the National Healthcare Group’s respiratory medicine residency, part of Dr Puah’s job also involves the training and education of young doctors.

As a regional health system for central Singapore, the National Healthcare Group has members that include not just TTSH and NCID but also Khoo Teck Puat Hospital, Yishun Community Hospital, the National Skin Centre, the Institute of Mental Health and polyclinics under the group.

Dr Puah said: “Everybody felt anxiety when Covid-19 first hit. It was perhaps even worse for the junior doctors as they have just started out in their career and were looking up to their seniors for guidance.”

Their education and training aside, Dr Puah said the pandemic showed that there was a critical need to support the psychological and mental well-being of healthcare professionals.

“At the beginning, the junior doctors were asking if they should segregate themselves and stay away from their families,” he said. At the time, doctors and scientists were still learning about the disease so some of younger doctors self-isolated out of caution.

“It was painful hearing how some of them postponed or cancelled their weddings, some having fully paid for (the reception and other arrangements). It definitely took a toll on them and there was a lot of sacrifice on their part to (segregate themselves and put personal matters on hold).”

On his part, Dr Puah still makes it a point to regularly check in on the junior doctors under his care.

Although he said that he has been “fortunate enough” not to encounter incidents of discrimination by the public, he has heard of nurses and doctors who experienced it over the course of the pandemic.

“I heard of people who got kicked out of their homes and it’s really sad to hear that.”

It has been reported that healthcare workers from TTSH had been told to leave their places of accommodation after the landlords learnt that they work at the hospital. 

Others from various hospitals had talked about difficulties booking a taxi or private-hire ride or receiving looks or unkind comments from strangers, for example.

HELPING PATIENTS BREATHE AGAIN

At work, Dr Puah finds it most fulfilling when critically ill patients turn the corner.

“I’ve always found that the scariest symptom is to experience breathlessness. To be able to relieve people of that sensation is really quite an achievement, I feel.

“Patients I see come in in their sickest state and to help them get out of it is a reward in itself.”

Dr Puah was among the first few doctors who managed Mr Raju, the migrant worker who was so ill with Covid-19 that he spent around two months in the ICU. Mr Raju eventually made a full recovery to return to Bangladesh to be reunited with his family and newborn son.

“Many people had a hand in his care. To see him get better and reconnect with his family was really a good moment for me,” Dr Puah said.

His experience with critically ill Covid-19 patients has opened up avenues of research that have made an impact on how patients are managed.

“One of the main things the team found was that placing Covid-19 patients in a prone position, (that means) making them lie with their chest facing downwards — even before they entered the ICU — helped improve their oxygen levels.” 

Placing these patients in a prone position improves redistribution of blood flow to areas of the lungs that are not affected by the disease. It helps the body take in a higher supply of oxygen.

Despite their best efforts, not all patients make it.

When asked if he ever gets used to seeing patients take their last breath, Dr Puah said that he went into the field with the understanding that death was something he had to face on a regular basis.

However, some of the cases he encountered have stirred deep emotions and really “stick with you” for a long time.

“There are some patients you can save and there are some you can’t. For those you can’t save, you support them till the end with dignity and give them comfort so they don’t suffer,” he said.

“For the Covid-19 patients who were not doing well, the saddest thing was that their family members couldn’t go in and say a proper goodbye in their last moments.

“That is something I really, really feel sad and bad about. But the disease is what it is.”

In such cases, the ICU team is guided by colleagues from the palliative medicine team on how to support dying patients as well as their bereaved families, for example, by helping them make video calls to say their final goodbyes or lending a listening ear to the grieving family members.

Dr Puah is mindful that his work with patients depends on rational decision-making. Letting emotions get the better of him and breaking down at work may also affect the team’s morale at a time when they need it the most.

“If (the junior doctors) see their seniors breaking down, I don’t know how that’s going to affect morale and how we can move on at work. And if I break down for one patient, what is going to happen to the rest who depends on us?”

FINDING STRENGTH AND PURPOSE

Having said that, Dr Puah said that his colleagues’ courage and strong sense of purpose in the past year have fuelled him, too.

“No one has backed out. Everyone came together and bravely went forward together, especially the nurses and junior doctors who go into the rooms, day in, day out, to closely treat the Covid-19 patients. When you see such bravery around you, it spurs you on,” he said.

Away from the frenetic pace at the ICU, the self-taught art enthusiast is armed with art supplies and materials.

He has completed a series of Covid-19-related art works dedicated to people affected by and working on the disease.

They include a drawing of an ICU staff member in full personal protective equipment that was done using watercolour pencils as well as one that features a pair of gloves being pulled on. He used the technique of pointillism, which is to apply small strokes or dots to a surface so that they make an image when viewed from a distance.

Aside from this, Dr Puah cherishes the time spent with his family, who has been a major source of strength and comfort during stressful times. His wife Joanne Seow, 37, a regulatory specialist in a pharmaceutical company, is a pillar of support.

“For every ‘win’ at work, they would celebrate it with me. My wife’s support has been tremendous. She was worried as well but we communicated constantly. We always found the time to share our fears with each other,” he said.

For their newborn, the couple take turns being caregivers together with a domestic worker.

Their oldest child is nine years old and the second is five. The two older children know about Dr Puah’s work and learnt about the pandemic in school.

Dr Puah said he was rather surprised that they readily adapted to certain new routines such as putting on a mask, even during the early part of the pandemic.

“They understand what is happening and I am surprised by how compliant they have been with the mask-wearing. Even my five-year-old masks up each time we leave the house.”