CARTAGENA. Work with a knot in your stomach almost continuously it is not easy to bear. the tension, Discouragement, the frustration, les hurry, The damn fever that does not go down, the endless pron maneuvers, the decompensation, The bitter taste that hammers his head for not being able to care for this patient any longer, the race against the clock from the first second you enter the ICU, this unbearable sound of the search that does not let you take your breath away, the face of fear of the patient, when told to intubate, the call the family… and, in the most serious cases, the death.
Arriving home, a sigh, breathing and not stopping to think, now with the descent that produces a very intense guard, which is just one more day, another day more in this damn battle against coronavirus, Of which no one knew anything less than a year ago and which has changed forever to auxiliaries, nurses and doctors of our Hospitales.
The numbers are discouraging, the ICUs are about to collapse and the list of deaths is not going down. We look at it with less and less empathy the cold data of infected, hospitalized, admitted a la FIA i dead, As if it were one more number on another day more of this endless, ungovernable and unattainable plague.
Those who fight it do not have time to see, analyze and interpret. Sthe day to day it is a parallel reality, a world infinitely distant from ours, In which life, thousands of lives, are played in a delicate game of chess, Where every piece, every move, every decision and any strategy counts; nothing can be left to free will, and not always earned.
Maria Galindo has been an intensivist for 18 years. He has worked at the ICU of Arrixaca and Saint LuciaSo, after so many years of experience in intensive care, what has happened to him in this little less than a year is not comparable to anything. He acknowledges that his day-to-day life is hard to explain, “exhausting” the accumulated voltage level is alarming, Both sometimes and the frustration of not being able to arrive and attend to everyone on time.
This week he has had to work at Rosell, in the ICU enabled by the growing number of cases. “The number of patients we have in charge of intensive care is increasing every day and that makes our guards exhausting.” informs the intensivist Murcia Square. So much so that they have to structurally surpass the ICU.
They have a limited number of beds in both Rosell and Santa Lucia (it seems obvious, but some haven’t noticed yet) (16 in Rosell and 27 in Santa Llúcia)But the demand for care for the sick covid has caused him to have to enable area of the hospital to care for critical patients where he has never been before. In this way, “it is very complicated both the day to day and the handling of the guard,” emphasizes Maria. There are many patients in charge of the intensivist, With a volume of work that patients with this pathology incorporate very high when they make the serious picture of admission to the ICU, “he postulates.
He acknowledges that what he has been experiencing for ten months would not have been imagined “Not in the worst of my nightmares. If they told me a year ago I wouldn’t have given credit. Between us we talk about that this is ‘war medicine’. We had to learn to work differently. The critically ill needs brutal meticulousness. A single patient can take you hours on guard, though the care pressure we are subjected to is also making us work differently, at a fixed price“Something we don’t feel comfortable with.” “It makes me nervous not to be able to dedicate more time than necessary to the patient who does need it”.
If the day to day running is an almost endless long-distance race, think about what’s left, with such horrific numbers of infections and deaths, it is impossible and not at all healthy. They prefer to do everything in the short term “so as not to come down to you, because we don’t see the end very clearly. We try to survive this by looking minute by minute.”
“It’s very discouraging,” he admits “And we’re looking for a way to endure it. I’m going to collapse several times and recompose myself so many more. The guard overhangs are complex. You’re depressed, when you get home you get the physical descent, but the mood isn’t bad. Teamwork (Nursing, auxiliaries, intensivists) it is crucial not to come down. cal tow what is worse at that time “.
The intensivist explains that when a patient arrives at the ICU with severe pneumonia, his treatment is perpetuated; the pathology is so severe that improvement is very slow, So you can throw in the ICU a month and a half or two months. “We didn’t notice a drop between waves”, Diu. The ICUs were filled because the covid patients came back in July “and we didn’t stop. When you have the high incidence of the new wave, you have not been able to discharge those of the previous one“So we’re carrying a workload that has been going on for many months now.”
Fatigue, isolation and fear
the patients arrive at the hospital very frightened. the Fear faces are evident because they are aware of their worsening. They arrive with fatigue and put on a mask and then another with more enriched oxygen. Later, the intensivist appears and tells them that they will go up to the ICU. “They are very scared because they see a worse progression of the disease. In addition, if the worsening continues and we have to explain intubation to them, it is normal for fear to paralyze them: that yes with the head and little more “, adds Maria Galindo.
Patients arrive at the ICU on respiratory arrest. He is a patient who has a situation of respiratory failure with severe shortness of breath. Blood oxygen decreases and needs to be intubated. “They’re sick people you can’t always make up for. That’s why we have to make one pron maneuver (Put them upside down, which is a way to work with the back of the lung, which usually improves oxygenation). This maneuver is very complex because the patient is sedated with tubes, tracks, probes, etc …, which requires a team of several people and extreme precautions. There are patients who require them almost every day. “
But as bad they go to bed intubated as the “Family anguish is brutal, because not being able to visit them is a horrible feeling. The uncertainty and anguish is tremendous for them: the great pain we see is the loneliness of the patient here and that of the family at home. “
This pathology requires isolation criteria, which prevents that doctor and patient can have a closeness typical of a situation as serious as the one they live in. It is not an open door box as it requires protection and insulation measures and therefore “We went in to serve them less than we would have liked”. The patient receives breath, but is not continuously accompanied “which is what he would need. This emotional support falls short “. Anxiolytic medication is therefore used to promote sleep.
Mass contagion equals high mortality. The percentages were higher in the first hour. In any case, it is a pathology that is “very demoralizing, because despite all our efforts, which are sometimes brutal, you see the patient get out of hand and that the picture progresses refractory to all measures. This does not make us want to work, because then there are the opposite examples and they are the ones that give you the strength to never throw in the towel, ”explains the specialist
recognizes that the patient profile has changed over the months, he is much younger, de forty to sixty years, With accompanying ages because they have no underlying pathologies and “who never throw in the towel”.
The bond with the patient is the other reward
The daily routine is complex seen from the outside. Dresses, glasses, gloves, masks, more suits, disinfection, gel. Every day at every hour we must try to be alert to avoid possible contagion with the patient. This huge handicap complicates something as crucial as direct dealing with the patient. If measured contact with the patient is added to haste and setbacks, the connection is not always easy. However, with those with a longer stay, it is with those who achieve a higher level of friendship. “Also with their families” says Mary. “In addition, they are patients with whom you have struggled so many days, which marks you more. Intubation involves you, unites us more to the patient. When you go in to talk to the awake patient, their last moments like that, you connect in that moment, you feel their fear and you try to encourage it. This moment binds you to the patient in a special way. Then they, when they are already at home, send you photos or send you something to the hospital; that is priceless, it is the best reward. “
Mary recognizes that it never ceases to amaze him with the staggering level of unconsciousness that is observed in some cases still on the street. She says she is as surprised as she is angry. “It is a behavior derived from the lack of information. When someone close to me asks me how I am, I tell them they don’t know the reality we are living in hospitals. It’s the only way I can explain this lack of prudence. Health resources are finite and this point may be reached due to lack of respirators, medication, etc … Statistics and how to calculate certain ratios are misinterpreted, Are data out of context they give the population peace of mind, when, on the other hand, we have a saturated ICU. These indices give a false sense of calm. “
Maria hangs up the phone after half an hour of conversation. It takes more than 20 hours on duty, A routine for her and her colleagues, doctors, nurses and assistants, a real ordeal for anyone. Remember it is part of your job, that while there are things that continue to irritate him, this is not the time to waste time in these fruitless debates.