On my first day of Covid ICU duty, I bled in my PPE. Periods happen, even in a pandemic

On Menstrual Hygiene Day, we can’t ignore millions of Indian women and girls who still don’t have access to safe sanitation — even in Covid pandemic and lockdown.

Dr Kamna Kakkar in a PPE suit | Photo source: Author

My first Covid-19 ICU duty was on 17 May in Rohtak, a day I will never forget. It was the first day I looked after patients of the pandemic, while bleeding through my personal protective equipment or PPE.

I bled freely that day, though not out of compulsion but by choice. I belong to the privileged strata of society where I never had to think about safely managing my periods. But that day, I felt what it was like to be in the shoes of women who do not have access to sanitary napkins or tampons or clean alternatives. What better day to share my story than on Menstrual Hygiene Day.

A disclaimer first: If a female doctor can’t talk comfortably about her periods, how can we expect society to? For those who think talking about this is too much of a taboo in a pandemic, please feel free to move on with your blissful lives, wrapped in a black plastic bag.

Donning and doffing

I am a doctor, training to be a specialist in Anaesthesiology. For us, on the frontline, PPEs include the coveralls that we wear over our scrub suits, along with the mask, the goggles and the face shield that protect us from getting infected by the coronavirus, or any other pathogen. It takes 45 minutes for us to wear the PPE in sequential steps — a process called ‘donning’. Then we follow a designated route to the Covid ICU where we work with the sickest of patients. When our shift ends, six hours later, we leave the ICU via another designated route to reach the ‘doffing’ area. ‘Doffing’, or getting out of the PPE, is another step-by-step process that also takes 45 minutes. Why is this important? Because it is relevant to my story.

On 17 May, just like any other healthcare worker, I reached my duty 45 minutes prior to my shift timing. I felt slightly bloated and had mild cramps in my abdomen, which I ignored thinking I might have eaten something spicy or unhygienic. In the rush and excitement to serve in the Covid ICU for the first time, I had completely forgotten that I was nearing the end of my menstrual cycle and it was time for my periods. All I could focus on was being in the midst of a pandemic and also needing to stay safe. I had completely forgotten that I had a woman’s body inside a frontline worker.

I took my sweet 45 minutes, donned my PPE, and walked into the ICU. There were five patients there, all with varying levels of coronavirus infections and all, undoubtedly, very sick. I had a junior resident doctor and a nurse to assist me for the next six hours. Having worn the PPE for the first time, I was struggling with perspiration in the 40°C weather, slight thirst and some claustrophobia from being packed in layers from top to bottom. Two hours into my shift, I felt something warm in between my legs. I immediately knew what it was — periods.

Free bleeding

I was unprepared. When you work in Covid areas, you go to work empty-handed. You do not even carry your keys or phone with you, let alone a sanitary napkin, to make sure you do not take infection back home.

I couldn’t risk leaving my sick patients unattended in the ICU for 45 minutes to doff plus 45 minutes to don the PPE again — a total of 1 hour 30 minutes — to just wear a sanitary napkin. Also, that would mean I would need another set of PPE, and in a pandemic, PPEs are precious and being rationed. I didn’t want to waste even one.

If I asked someone to substitute for me, it would again utilise three new PPE kits — two for me and one for the other doctor. My seniors were busy with important administrative work, so I didn’t think it would be right to disturb their momentum. They were the ones doing the important ‘preparedness’ job, which includes procurement of necessary equipment, drugs and other items to make sure the Covid ICU is functional.

My uterus getting rid of its endometrium at this hour was my own personal hilarious tragedy.

I finally decided, I’ll bleed till it doesn’t show.

Even if it did show, it wouldn’t have mattered. PPEs are designed to be completely water proof, and a little bit of bleeding wouldn’t affect me or others because all of it would be contained inside my scrub suit and PPE.

I wasn’t distressed. In fact, free bleeding felt completely natural (because it is). Yet, I missed the security of having a sanitary napkin tucked between my thighs dutifully absorbing the blood. I missed not having to worry about infections. There is an infection called Toxic Shock Syndrome, caused by a bacteria called Staphylococcus aureus, which can potentially kill you if you’re not careful with your menstrual hygiene. I missed the safety of not soiling the scrub suit I was wearing. I realised how privileged I have been all my life to have access to menstrual hygiene products. My duty went on for the next four hours, and I was too engrossed in patient care to even think about my periods any more.

Nothing heroic

Had there been no coronavirus pandemic, my female colleagues would have offered me sanitary napkins, my male colleagues would have told me to take it easy and take the day off. Because when you’re a doctor, surrounded by doctors, menstruation is not a taboo.

Having seen the human body and its intricacies so close, no healthcare worker holds any bias against the functioning of a body, male or female. No one has ever felt uncomfortable seeing the ‘wings’ of a sanitary napkin peeking out from our underwear when we wear our scrub suits every morning in the changing room. No doctor is bothered if you’re a patient getting operated for appendicitis and are on your period.

As soon as my shift ended, it took me the usual 45 minutes to doff the PPE and discard it. I took a bath, washed the soiled scrub suit, and dipped it in antiseptic solution. I texted my friend about the ordeal while going back home. I was surprised by her response. She called me a ‘true warrior’ who bled on the line of duty. I was flustered at the flattery. Am I not just another regular woman doing my job. Regular women menstruate while working — nothing heroic about it. However, unlike me, who bled freely by choice, if one has to menstruate without a pad or a tampon out of compulsion, it makes her a victim of social apathy.

The Indian women labourers who’re delivering babies on the road, and within an hour, walking back home —are they heroes? No, they’re victims too. They’re losing blood with every step they take.

Only 36 per cent of 336 million menstruating girls and women in India use sanitary napkins. How have the rest managed so far? In India, 23 million girls drop out of school annually when their periods begin. Most cite lack of access to toilets and clean water as the reason. Aren’t they all victims of ‘period poverty’?

The least we can do is talk about it. Periods can happen during pandemics, cyclones, riots, earthquakes and Covid-19 infections. And ensuring menstrual hygiene is as important as ensuring food, water, shelter and treatment.

Talk about it, so they can hear.

After my experience, we are making a duty roster for the Covid and non-Covid wards keeping in mind everyone’s menstrual cycles. I thank my department and my institute, Pt. B.D. Sharma PGIMS, Rohtak, for making it a wonderful place for women to work in. If they had known of my ordeal, my department would have gone out of the way to help me, but I decided against disclosing it at that moment, for which I take full personal responsibility.

The author is a junior resident doctor in Anaesthesiology with a keen interest in women’s health. Her Twitter ID is @drkamnakakkar. Views are personal.