Returning to Heping Hospital, Ward B8: “Her answer signalled her choice”

17 years ago, the SARS epidemic led to the deaths of many citizens and healthcare workers in Taiwan. The Heping Hospital in Taipei was quarantined and locked down. In the fight against an epidemic under the most dire circumstances, how was the balance maintained between personal choices, defending humanitarian needs and the duties of healthcare workers?

“I think they saved me.” Yang Chih-hsien, Division of General Psychiatry, Taipei City Hospital Heping Fuyou Branch, still remembers what the nursing staff of ward B8 said to him. 

It has been 17 years since the SARS outbreak. He still works as a psychiatrist in the psychiatric rehabilitation centre of the same hospital on 10/F. Just two floors below the centre is ward B8 which was dedicated for treating severe SARS patients when Heping Hospital was locked down.

On 16 April 2003, a SARS patient named Lau, a laundry worker, was admitted to ward B8. Since then the virus spread out of control in the ward. Head Nurse Chen Ching-chiu and Dr. Lin Chung-wei were the first medical staff to die from SARS in Taiwan. They were responsible for the care of patients in ward B8 and not knowing the patient they were handling had contracted SARS, they did not put on protective gear and were thus infected. 

On 26 April, after 3 days of lockdown, the anarchic ward finally got some external aids. Academia Sinica epidemiologist Dr. Ho Mei-Thang with a team of experts from the U.S. Centers for Disease Control and Prevention (CDC) visited Heping Hospital to help investigate and control the outbreak. Yet, no one in the hospital, for fear of contracting SARS, was willing to take the risk to lead the experts to Block B and show them all the floors. The secretary of the Hospital Director, after exhausting all options, came to Yang. Since becoming a psychiatrist, Yang’s knowledge of medical, surgical and infectious diseases was fading away. When the secretary stressed to him that she “could not find anyone any more”, he agreed despite feeling puzzled.

The words from “hell” dispelled all his internal struggles

 “What a hell!” These were the first words from the CDC experts the moment they walked into Heping Hospital. Then they were stunned when they learned that their guide was a psychiatrist. Yang recalled, “The expert called John questioned in shock, ‘What? You are a psychiatrist! You have no other medical doctors?’ The next second, he said, ‘Forget it. We have no time.’”

When they got to ward B8, the SARS epi-center, Yang introduced the experts to the medical staff there, “Both local and overseas experts are here now to help us. Feel free to tell them whatever is needed.” These colleagues were in full protective gear, worked for long hours without food, saw co-workers fell ill one after one, were questioned by the public for not doing their best, were avoided by peers in the hospital and could not get anyone to join their team. Yang expected these isolated and helpless frontline colleagues to vent all their frustrations, difficulties, helplessness and anger. 

“Dr Yang, we do not really need help. We are very happy that you and the experts are willing to come to see us. Others will not come.” 

Before Yang stepped into Block B, he was pretending to be strong. Deep down inside, he was struggling with fear and questioning whether he was too reckless. He was in awe when he heard this unexpected answer, which summarily dispelled his internal struggles.

“Comparing myself to them, I felt ashamed. Suddenly, I felt empowered and energised. The fear at the bottom of my heart vanished. I saw these medical staff in Block B warding off SARS, holding fort there unwavering, fearless of death and being altruistic for the care of the patients. Witnessing how much they had done for us, lifted my spirits and I also became confident,” said Yang. On the same day, a patient hanged himself in the bathroom which sent the morale in the hospital from low to rock bottom. Li Huei-wen (translation), the then Director of Psychiatry, was responsible for comforting the two nursing staff who discovered the body, while Yang dealt with informing the deceased’s family.

“This patient was admitted to the hospital because of SARS and his wife was also quarantined at the hospital because of accompanying him. One day, his wife had a fever and was brought to the emergency room to be tested for SARS. He could not stand the guilt of infecting her with SARS and killed himself while waiting for the test result.” Yang said.

“At that time, I suggested that we not tell his wife about his suicide immediately for fear she might breakdown emotionally. Instead, we asked their daughter to tell her mother about his suicide. Yet, their daughter had to file a special application for entry into the hospital and we had to ensure she could leave the hospital after her entry. Otherwise, the mother might end up feeling extremely guilty -- her husband killed himself because he felt guilty, and thus she might have blamed herself for his suicide. On the top of this, if her daughter could not leave the hospital afterwards , she might feel even more guilty and attempt to kill herself as well. This family would collapse like falling dominoes.”

When their daughter came to the hospital, Yang counselled her to promise her mother that although her father left them, she would stay strong and take good care of herself and wait for her mother to come back from quarantine. Her mother also promised her daughter that she would stay strong and live her life for her husband and daughter.

You will see all the facets of humanity but the only thing you could do is reflect upon yourself

Different from the present Taiwan government which has been dealing with COVID-19 effectively and seriously, and being transparent to the public, SARS was like a bomb that exploded at Hoping Hospital. Things fell apart suddenly for the quarantined. They could no longer live life as they did before. Without the necessary knowledge and aids, they were all trapped in an abyss.

When Yang was notified of the hospital’s lockdown, he had just finished the morning shift. He then rushed home and told his family what might happen next and how they could deal with it. While he was packing his clothes and books, a book by Nietzsche caught his eye -- the book ended up supporting him mentally during quarantine. 

“In a situation of absurdity and emptiness, humans have to make choices bravely and take action. When being trapped in a process of things falling apart, you can build a new reference point through action. It is like being able to touch the bottom of the abyss. In doing so, you can stay confident about the possibilities of life.” Yang emphasised.

“Nietzsche argued that ‘God is dead’. He was referring to extreme situations, where a man cannot seek help from others, neither from an institution nor other individuals. He can only rely on himself. He also introduced the concept of ‘the will to power’ — with the will power to soldier on till the end, a man will become a ‘superman’ capable of breaking through the limits in life. Being a superman is not about being greater than others, but about how to get out of a plight with positivity.”

During the anarchic hospital lockdown, people inside were like being trapped on an isolated island where everyone survived by instincts. Human weaknesses were revealed one after one. A doctor cordoned himself off in a corner, watching soap operas on DVDs all day long and not allowing anyone to approach him. When Block B medical staff took their protective gear off and took a rest at the Alternative Military Service Centre as arranged by the city government, some Block A colleagues in the Centre became hysterical and asked them to leave fearing they might spread the virus. Even Yang’s wife who voluntarily quarantined herself at home lost her sleep as she was harassed by the neighbours through a barrage of phone calls as if she also contracted the virus. For those on duty in isolation wards, their families were all stigmatized.

“When being isolated, I witnessed all facets of humanity and the only thing I could do was to reflect upon myself. I think that signalled a choice, like the choice of those medical staff in ward B8. When I asked them what help they needed, at that moment, her answer signalled a choice. An ‘existential’ choice,” Yang concluded.

Source : The Reporter, March 2020 ( https://www.twreporter.org/a/sars-memories-life-under-quarantine-in-heping-hospital)