SINGAPORE: The eve of Hari Raya Puasa is a day usually spent with family, breaking fast for the final time at the end of Ramadan, and preparing for a day filled with festive cheer.
On Saturday afternoon (May 23) in Ng Teng Fong General Hospital’s intensive care unit (ICU), Mr Efendi Abdul Rahman, 43, had something to cheer about too.
Sixteen days ago, he was wheeled into the ICU with a breathing tube inserted into his mouth. COVID-19 had ravaged his lungs so much that he was barely getting any oxygen. He was eventually put into an induced coma and on a ventilator.
Now, Mr Efendi's condition had drastically improved. He still had a tube in him, this time through his neck, so he couldn’t talk. But he was conscious and communicating, by using a black marker on a little whiteboard.
It was a high point in a battle that has taken Mr Efendi to the edge of death and back, and his wife and seven children through sadness, anxiety, relief and happiness.
Last week, CNA reported how his wife Mrs Sharifah Radiah Ameer, 42, and the children were coping with the ordeal while being quarantined at home. With her permission, CNA spoke to Mr Efendi's doctors on Saturday regarding his condition.
READ: For mum of 7 with husband fighting COVID-19 in ICU, home quarantine is an anxious but tight-knit affair
That day, the hospital team thought Mr Efendi had some cause for celebration, especially with Hari Raya just around the corner.
So the evening before, Dr Shanaz Matthew Sajeed, the intensive care medicine consultant who was on the night shift at the ICU, dropped by Mr Efendi’s home on the way to work. It was a five-minute drive from the hospital anyway.
The doctor picked up two pieces of clothing: A batik shirt he often wore, and a blue baju kurung made of cotton. Mr Efendi would put the batik shirt on during a video call with the family the next day.
“It was my head of department who mooted this idea to consider getting some kind of clothing for him for his Hari Raya celebration,” said Dr Shanaz, who did not enter the home, wore a mask and kept a safe distance when he picked up the items.
During the WhatsApp video call the next day, Mrs Sharifah said her husband was in “better spirits”.
They talked about celebrating Hari Raya, and he wrote that he would very much like to be back with them. He did a little jig with hands that his son loved to see him do. He curled his fingers into the shape of a heart for his children.
“He was smiling today, and while communicating to his family we could see there were a lot of emotional moments,” said intensive care medicine consultant Dr Monika Gulati, who is also on Mr Efendi’s ICU team.
“His family was obviously very happy to see him alert and awake, and he’s looking quite motivated. So we all hope Efendi continues on the path of recovery.”
ON THE EDGE
But as with many critical medical conditions, things hadn’t always run smoothly.
Just a few days back on Wednesday, Mr Efendi’s heart had simply stopped beating. As the virus attacked his lungs, air built up around them and pushed against them, so doctors needed to put a drain in to relieve the pressure and let them expand.
“His lungs are infected with the virus,” Dr Monika said. “This complication which happened in this state of fragility probably tipped him over.”
Like clockwork, the team did cardiopulmonary resuscitation and pumped in the necessary drugs, getting a heartbeat back within minutes.
“This is something that we are trained for, it didn't catch us by surprise,” said Dr Shanaz, who had put the drain in.
“We were very well-prepared for it, and because of the quick thinking of all the members of the team in the room and outside of the room, we managed to secure his airway and bring back his circulation within minutes, with no damage whatsoever to his brain that we could observe.”
While emotions were ice-cool in the ICU, Mrs Sharifah reacted differently after getting a call from the team that morning.
“I had a late night, so I was drowsy,” she said. “And when they said that, my heart stopped. I just went numb. He may have died, and I wondered if I had been too happy the day before.”
Mrs Sharifah had video called her husband the day before. It was the first time she had seen him conscious since he was admitted.
“He was very drowsy, but still he managed to ask for the sixth one, my eight-year-old,” she said of that call. “I cried tears of joy.”
So it was tough on Mrs Sharifah that her world came crashing down again the next day, as she recalled feeling “empty”.
“I was moody; I forced myself into conversations,” she said. “My kids hid their feelings well, but I knew it affected them too. It was more helpless as we were still in quarantine.”
Still, Mrs Sharifah was relieved that her husband survived the incident: “I felt that God had answered my prayers.”
ROAD TO RECOVERY
Dr Shanaz believes this episode occurred as Mr Efendi’s condition had been improving since his early days in the ICU, when he arrived “critically ill”.
The first five to seven days were “quite an intense period” where his life was in danger, Dr Shanaz said, noting that he also needed dialysis for his kidneys and support for his blood pressure.
“The moment that patient is on a ventilator and requiring support for his organs and blood pressure, we are concerned for the patient's life,” he added.
Roughly a week into his stay in the hospital, Mr Efendi’s oxygen levels remained critically low, as doctors considered using an urgent but riskier form of ventilation known as extracorporeal membrane oxygenation (ECMO).
This involves pushing a patient’s blood through a machine that adds oxygen and removes carbon dioxide before pumping it back into the body. But because this procedure requires blood thinning, it carries a significant risk of bleeding.
“The fact that he was considered for ECMO itself, marks him as a patient who would be considered at very high risk,” Dr Monika said.
READ: 'The hardest thing I've been through': Hallucinations, fever, pneumonia - but finally victory for this COVID-19 patient
However, Dr Shanaz said the team eventually decided on a “more unconventional ventilation strategy” for Mr Efendi that led to significant improvements.
“At that point, we were sort of cautiously optimistic,” he added. “He was improving and he got to a point where his oxygen requirements had dropped significantly, they were much lower than what he initially started off with.”
Mrs Sharifah shares this cautious optimism, saying there’s no rush and that she just wants to see him get better.
“We're all doing okay,” she said. “There is enough to keep us going for now. When he gets better and decides to retire or whatever, he has our support. Things will never be the same, but it's a fresh start. That's good enough for me.”
She said the kids are happier too. “Maybe when he was in a coma, they were thinking about a bleak future,” she added.
“Seeing their father now that way, they seem to have their own perseverance to want to succeed and help him.”
“IT VALIDATES WHAT WE DO”
While Mr Efendi is now on the slow road to recovery, Dr Shanaz stressed he isn’t completely out of the woods.
“For the next stage of recovery, we want to see that he has good physiotherapy, we want to get him strong again,” he said.
“We want to make sure that he is able to take good breaths, is able to cough well, regain his strength and then take it from there.”
To leave the ICU, Dr Monika said Mr Efendi must first be taken off breathing support. Still, he has been getting back some strength, enough to write, and is “heading in the right direction”.
It is a huge change in fortunes considering both doctors agreed Mr Efendi was one of the most severe cases of COVID-19 they had attended to.
“Both of us would say that it's hugely satisfactory to see a patient, that is on the verge of dying, being brought back to life and then recovering and then eventually thriving,” Dr Monika said.
“He hasn't got to the thriving stage yet, but that's what we hope to see for him, and that is of course, hugely satisfying. It validates what we do on a day-to-day basis. It makes the long nights and the long hours worthwhile.”
Mrs Sharifah said the team at the hospital has been “amazing and I am forever grateful for their efforts”.
“They did a great job,” she added. “I mean, it’s not easy to meet people's expectations, to keep him alive and not disappoint his family.”
On Saturday, Mr Efendi scribbled a message on the whiteboard for the team that has been caring for him. “Thank you all,” it said.
For Mrs Sharifah, it was a different experience seeing her husband in traditional Malay garb lying in a hospital bed surrounded by tubes and wires.
“He looked different in every way, his face and eyes,” she said. “Maybe it was an effect from the meds. I'm sure once everything is sorted out he will be okay.”
Ms Ong Mei Yan, a medical social worker at the hospital who has constantly been in touch with Mrs Sharifah, said the family has supported each other well.
“Being stressed and having anxiety is actually very normal during a crisis situation, especially in such a difficult time,” she said. “But she has personally displayed resiliency, as well as optimism with Mr Efendi’s situation.”
Ms Ong said the pandemic has forced hospital staff to find creative ways to connect patients with their loved ones, including setting up video calls and this mini Hari Raya celebration.
For obvious reasons, Mrs Sharifah said Hari Raya for her this year won’t be especially festive, although she acknowledged that life has to go on.
Mr Efendi is certainly looking forward to resuming life with his family. “I want to go home tomorrow,” he wrote on the whiteboard.