A sense of direction

Jiang Li, director of the department of critical care medicine at Xuanwu Hospital, Capital Medical University, starts her work day by going around ICU wards to check the patients as early as possible before the formal ward inspection during shift change.

In between, she usually makes coffee for herself and her team, sometimes even producing some latte art for them.

Since COVID-19 pandemic hit China in December, Jiang, 51, has only spent a few days in her wards-as the expert from the National Health Commission, she spent three months in Wuhan, capital of Hubei province treating seriously ill patients on the frontline until the last COVID-19 patient in Wuhan was discharged on April 26.

Two months later, when a second wave of the virus hit Beijing, Jiang went to the frontline alone again-she joined the team at Beijing Ditan Hospital, Capital Medical University to treat the patients.

"Drawing on experience gained from Wuhan, this time the treatment was not as hurried," Jiang says.

By Aug 6, all 335 COVID-19 patients related to Beijing's Xinfadi wholesale market had been discharged after the unflinching 56-day effort of Jiang and the medical team.

Jiang heads to Wuhan on the second day of the Spring Festival to tackle COVID-19. [Provided to China Daily]

Team building

A day after the Chinese New Year, Jiang took the train to Wuhan, the Chinese city hit hardest by COVID-19.

The next day, she started work in Jinyintan Hospital, one of the designated hospitals for COVID-19 patients in Wuhan, where regular wards had been repurposed into the 30-bed ICU she took over.

The work waiting for her was tough. She not only had to establish a workflow in the special wards, but also coordinate a team made up of medical staff from different hospitals with different professional backgrounds, working practices and habits.

"The communication between the ward and the outside working zones only took place via two way radios then, and the doctors who were in the wards were not able to see the patients' information, such as laboratory test reports," Jiang recalls. "With the limited protection equipment available at the time, we couldn't just walk onto the ward to treat the patients whenever we needed to like we can in a normal ICU, but we had to maximize the work when we were inside."

Jiang figured out a clumsy way-a doctor always brought a piece of paper onto the ward, upon which he or she would have written down key facts and figures of the patients and their planned treatment.

"After seeing the patients, the doctor would write down what treatment needed to be changed or adjusted on the paper and paste it to the window so that another team member outside could take a photo and pass the message on to the wider team," Jiang says.

"Not a single needle could be brought out of the wards because of the highly infectious nature of the disease, so we could only use this system," she says.

To ensure the cooperation between team members ran smoothly was another challenge-the slang used to describe certain medicine or procedures, to the sequential order of an operation all need to be unified.

"For example, the nurses had to fully understand the doctor's prescription including drug dosage and the infusion speed," Jiang explains, adding that some of the nurses were not trained to work in the ICU, meaning that they needed to get up to speed very quickly.

The team workflow was gradually established by Jiang and other members continually changing and perfecting the rules until it was on the right track.

Learning to adapt

A new patient was admitted to Jiang's wards on Jan 29. He was a physician of neurology and became infected after performing a procedure on his patient.

"Looking at his blue lips and the increased ventilator pressure, I prayed silently that his condition would get better. The novel coronavirus pneumonia causes many patients' condition to deteriorate sharply and they won't recover easily," Jiang writes in a Chinese journal.

On the fifth day, when entering the ICU, Jiang noticed that some new medical staff had written their names on their protection garment-they were ICU nurses from all over the country sent to help Wuhan.

The workflow gradually got smoother, several seriously ill patients were stabilized and, after several cloudy days, the sun finally came out.

Jiang says that when the medical team started drawing small cartoons on their protective clothing, it meant the situation in Wuhan was improving and the pressure on doctors and nurses was easing.

"In the first few days we were under such great pressure that we didn't even think of writing down names, there wasn't even a marker pen there. Sadly, I can only remember some pretty eyes with no name that worked with me then," Jiang says.

Besides taking care of her patients, Jiang also joined an expert team to patrol designated hospitals in the city for COVID-19 patients to find the potentially seriously ill patients and arrange special monitoring or transfer to the ICU wards.

"It's crucial for a potentially seriously ill patient to be identified early," Jiang says.

During each patrol, Jiang would check on each patient's vital signs, their degree of difficulty in breathing and their oxygen saturation, as well as taking a little time to observe suspected cases.

"If a patient's lips turns a little blue, it means their blood oxygen saturation has dropped and if a patient is using the accessory respiratory muscle that should not normally be used when breathing, they also need more oxygen," she says.

From early March, Jiang's daily routine included one more item on the agenda-if there was a COVID-19 death the day before, all doctors in charge of each ward zone in designated hospitals would gather together for a review and a group discussion.

The meetings, which could last anywhere up to 4 hours, would be attended by more than 40 doctors and experts.

"The doctor who took charge of the patient would make a report giving an overview of the whole treatment process, and then all of the doctors would discuss what could have been done better," Jiang recalls.

She thinks it was an effective way for doctors to learn about the new disease and about the effects of different treatments.

"Even though we could not bring the lives of those patients back, the discussion was helpful for the patients still fighting," Jiang says.

Jiang believes that conducting autopsies is a necessary and meaningful procedure as the pathological conclusion provides the final answer of what happened to the patient.

On April 26, all COVID-19 patients in Wuhan were discharged. Jiang took the train back to Beijing a day later.

Lou Ran, an ICU doctor in Jiang's team in Beijing, recalls that when Jiang returned from Wuhan, she looked bad. "She didn't lose any weight, but she didn't say a word about getting tired," Lou says.

When Jiang was in Wuhan, she still cared about her patients in the ICU wards in Beijing. Each day Lou and other doctors on watch sent her updates about the patients. "She replied every day, sometimes at 12 am, sometimes at 5 am," Lou says.

ICU doctors need a long period of training and a wide range of knowledge. Jiang has been an ICU doctor since 1992.

Lou says when she reads about a rare disease, she will often ask Jiang about it. "I have never caught her out, she always knows," Lou says. "When she is not that familiar with the disease, she will search for some literature about it and share it with us that same day."

ICU doctors and nurses have played an important role in fighting COVID-19, Jiang thinks the building of a solid ICU team is the key to successfully facing a future epidemic.

"Seventeen years ago, we joined the fight against SARS, and hopefully, in the future, the young doctors will carry on our duty," she says.