Peng Ji: “Be hopeful”—an intensive care doctor’s message from Wuhan

Peng Ji shares her initial experiences of dealing with covid-19 in Wuhan and her optimism that we can overcome it

I am an intensive care physician from Chengdu, China and in early February I volunteered to join the efforts in managing the covid-19 outbreak in Wuhan.

I wrote this Q&A a few days after my arrival in response to the questions and messages I was receiving from friends and family reaching out with well wishes. My initial post on WeChat was read by 300 000 people in China. Here is an edited version of that post. As countries around the world face their own struggle with covid-19, I hope that my experiences in Wuhan may provide hope and encouragement to other healthcare teams.

What are conditions really like in Wuhan?

This was not totally clear to me in the first week. The first couple of days were filled with familiarising ourselves with the working environment, streamlining processes, and a plethora of other arrangements. I felt that my awareness of the overall epidemic was keener when I was at home in Chengdu. In Wuhan we have to take things as they come: focus on the task at hand, take care to properly protect ourselves, and put our entire being into the cause so that one more person might have a better chance of surviving.

I recognise that my observations may not be as global or objective as I would like, but things do not seem to be as terrible as social media has portrayed them to be. Systems have been developed to streamline treatment processes by triaging patients into mild, moderate, and severe categories for individual care. The mechanical ventilator we applied for on the second day arrived and was already in use the following day. Every day we work in groups to brainstorm how to be more efficient and how to modify traditional bedside clinical care to compensate for the limitations that covid-19 places on direct patient-doctor interactions. Considering all that’s involved, to me it seems not so bad.

Is it scary?

To be honest, it’s still scary, even with all the measures we have in place. The image of “heroes in white, running towards danger” is just a glorified title. Deep down, I’m still scared of getting infected and scared of dying. When it was confirmed that I was going to Wuhan, I tossed and turned in bed that night, my mind racing. We all have our own personal relationships that make it difficult to leave. My decision to go feels like it puts my life at risk. In reality, it is our loved ones that carry the burden and live in fear while we are praised as heroes. So yes, of course it’s scary. 

I can’t claim to have any grandiose reasoning for going. For ICU doctors and medical professionals, saving lives is what we trained for. But this does not mean we are ignorant of our own safety and that we disregard the risks. 

When I arrived, I was immediately in awe of the meticulous protocols the hospital had implemented for infection prevention. The spectrum of guidelines has been extensive, covering large scale issues like arranging the work-life space for maximum safety, to matters such as how to put on protective gear, take showers, disinfect clothes in the hospital, disinfect and change face masks, wipe down our feet before returning to the hotel, and even how to take off and wash our clothes and shower. Even details like where best to hang our clothes and how to best disinfect our rooms have been thoroughly considered. People watch and help us when we put on and take off our protective gowns to ensure it’s done properly. One day, we noticed there wasn’t a mirror; the next day one was brought in. 

Protecting ourselves is the first victory. And while this victorious flag may be premature, at least the teams here have truly exhausted all ideas to come up with the best plan to protect us. I may not be fully safe from everything but I am, at the very least, less afraid. 

Are you tired?

Yes. My body is tired. My heart is tired. I wash my hands obsessively. I change and wash my clothes every day; soaking them in sanitising solution. All the surfaces in my hotel room are wiped down and disinfected daily. I scrub my face multiple times. It feels like I spend my day soaking in a pool of disinfectants, exfoliating and washing away germs. 

But my exhaustion is nothing compared to the local doctors of Wuhan. While the media has exalted us all as heroes for coming here, they are the ones who have been here working since late January. On my first night shift, I worked with a Dr Ding, who had bloodshot eyes from working for 22 days straight, with a night shift scheduled every three days. When he’s off shift, he’s under quarantine. All of the subspecialties in the hospital have been merged so the entire hospital is focused on taking in all the patients with covid-19 that they can. That night, I couldn’t help but think that these people have done everything they could, and that whatever they have yet to do, they are working hard to accomplish. 

Is this depressing? 

No, not at all. Coming here has allowed me to put all my energy and capabilities into a good cause. Professional status and titles have dissolved. Simple things like lining up for the elevator, everyone contributing to the hustle and bustle of procedures, our lively discussions in the group chat, helping each other in and out of the protective equipment, cutting each other’s hair (of course, before first arriving to the hospital), writing names and encouragements like “fighting” on our gowns, are all precious moments. In the future, I will always see them as rare and beautiful memories. 

What about the nurses?

Society, especially the traditional Chinese medical system, has often regarded doctors as having more authority, standing, and experience than nurses. Yet in many ways, nurses are the medical professionals most worthy of praise. It’s the nurses who are with the patients 24 hours a day. The isolation ward has been designed to minimise contamination, so all personnel numbers have been drastically reduced, which leaves the nurses to do it all. They are responsible for cleaning the ward, handing out hot water, delivering meals, administering shots and IVs, performing bedside ECGs, conducting blood tests and arterial blood gas analyses, checking vital signs, and so much more. Everything you can and can’t think of, what is and isn’t in a nurse’s job description, anything the patient needs outside the doctor’s responsibilities, all fall on the shoulders of our nurses.  

Nurses are often hidden from the spotlight, but society owes them the utmost respect. 

Now what’s next?

Amid population expansion, human migration, and globalisation, the spread of infectious diseases is an inescapable challenge. Our country sent more than 40 000 medical personnel and countless others to respond to the outbreak, assembling massive supplies and resources. With these efforts, the epidemic in Wuhan seems to be contained. However, while the volume of cases has decreased, the city is still under lockdown as we proceed with caution. 

What can people in other countries do now that they are also facing the spread of this virus? Do well to protect yourself, wash your hands, wear protective equipment when appropriate, speak up about good infection control practices. Protect yourself from the disease, but don’t close yourself off from other people. Actively work hard to improve the status and treatment of nurses. And above all, be hopeful. 

Through our efforts these past three months, China is now beginning to see a light at the end of the tunnel. I believe that by working together as a unified world and by sharing experiences, we will without a doubt overcome this. 

Peng Ji is an ICU specialist working in the Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu.

Competing interests: None declared.

Acknowledgement: Thanks to Annie Wu for the translation. Thanks to Dr Yan Kang, Dr Steve Schwartz, and Bistra Zheleva for the critical review and editing suggestions and my team for the support. Thanks to all of the medical professionals who are contending with covid-19.