CARTAGENA. Work with a knot in the stomach almost continuous is not easy to deal with. The voltage, discouragement, frustration, the prisas, the damn fever that won’t go down, the endless one amenable maneuvers, the decompensation, the bitter taste hammering the head for not being able to help this patient anymore, the race against time from the first second you enter the ICU, that excruciating sound of the beeper not letting you breathe, the patient’s face in fear, when he tells him to intubate, the call family… And, in the most severe cases, the death.
Go home, sigh, breathe and don’t stop thinking, now with the downturn caused by a very intense guard, which is just one more day, another day in this fucking fight against the coronavirus, which no one less than a year ago knew about and which has changed forever to assistants, nurses and doctors of our hospitalss.
The numbers are daunting, ICUs are on the verge of collapse and the death list is not disappearing. We look with less empathy every time the cold data of infected, hospitalized, entered in the FIA Y passed away, As if it were one more song another day of this endless, uncontrollable and endless plague.
Those who fight against it don’t have time to see, analyze, and interpret. S.you from day to day It is a parallel reality, a world infinitely distant from ours, in which the life, the thousands of lives, be played a delicate game of chess, where every piece, every move, every decision and every strategy counts; nothing can be left to free will, and it is not always won.
Maria Galindo He has been an intensivist for 18 years. He has worked in the UCI of La Arrixaca and Santa LucíaTherefore, after so many years of experience in intensive care, what happened in this little under a year is unlike anything else. He recognizes that his daily life is difficult to explain, ‘exhausting’ the level of tension built up is alarming, sometimes as well as frustration because you couldn’t arrive on time and everyone could help.
This week he has had to work at Rosell, in intensive care, made possible by the increasing number of cases. “The number of patients we have in charge of intensive medicine is increasing every day and that is making us major shifts” the intensivist reports Murcia Plaza. To the point that they have to structurally transcend the ICU.
They have a limited number of beds in both Rosell and Santa Lucía (it seems obvious, but some haven’t realized it yet) (16 in Rosell and 27 in Santa Lucía), but the demand for care because of the patient problem covid has made it necessary to enable a hospital environment to care for critical patients where it has never been before. In this way “it is very complicated, both day to day and for the management of the guard”, María emphasizes. There are many patients in charge of the intensivist, with an amount of work that patients with this very high pathology take up when they undergo a serious admission to the ICU, ”he adds.
He acknowledges that what he has lived for the past ten months he could not have imagined “not in the worst of my nightmares. If they had told me a year ago, I wouldn’t have given it credit. We talk about it between us this is from ‘war medicine’. We have had to learn to work differently. The critical patient needs brute rigor. A single patient can put you on a watch for hours, but the pressures of healthcare that we are exposed to are also changing the way we work, little by little, something we don’t feel comfortable with at all. “It causes a” huge inconvenience “, “It is nerve-racking not to be able to spend more than necessary time with the patient who does need it”.
If the day to day is an almost endless long-distance race, think what’s left, With such terrible infection and death rates, it is impossible and unhealthy. They prefer to do everything in the short term “so as not to collapse, because we don’t see the end very clearly. We try to survive this by watching minute by minute.”
“It’s very discouraging,” he admits “And we are looking for a way to deal with it. Every day I collapse several times and often relax. Waiting lists are complex. You are depressed, when you come home you feel the physical decline, but the mood is not bad. Teamwork (nurses, assistants, intensivists) It is essential to avoid falling apart. Must subtract the worst at that moment. “
The intensivist explains that when a patient with severe pneumonia arrives in the ICU, his treatment lasts forever; the pathology is so serious that the improvement is very slow, so it can be thrown in the IC for a month and a half or two. “We have not noticed a drop between waves”, He says. The ICUs were full because the covid patients came back in July, “and we haven’t stopped. If you have the high incidence of the new wave, you have failed to discharge that of the previous oneThat’s why we’ve been overworked for months. “
Fatigue, isolation and anxiety
The patients arrive at the hospital very scared. The scary faces are obvious because they are aware of their deterioration. They arrive tired and put on a mask and then another with the richest oxygen. Later, the intensivist appears and tells them they are going to the ICU. “They are very scared because they see a worsening of the disease. If the deterioration continues and we have to explain the intubation to them, it is normal for fear to paralyze them: they nod their heads and little else, ”adds María Galindo.
Patients arrive in the ICU with respiratory failure. He is a sick person who has a situation of respiratory failure with severe shortness of breath. Blood oxygen decreases and must be intubated. “They’re sick that you can’t always compensate. That’s why we need one amenable maneuver (put them face down, which is one way of working with the back of the lung, which usually improves oxygenation). This maneuver is very complex because the patient is anesthetized with hoses, lines, probes, etc …, which requires a team of several people and extreme precautions. There are patients who need them almost every day. “
But they intubated it in bed as bad as “Family fear is relentless, because it is a terrible feeling not to be able to visit them. The uncertainty and the suffering are enormous 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 occurs doctor and patient may have a close relationship typical of a situation as serious as the situation in which they live. It is not a box with open doors, as it requires protection and insulation measures and therefore “we go in to serve them less than we would like”. The patient receives encouragement, but is not continuously guided “, which is what he would need. That emotional support is inadequate “. Anxiolytic medication is therefore used to promote sleep.
Mass contamination 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 can see the patient getting out of control and that the table becomes insensitive to all measures. That doesn’t take away our desire to work, because then there are the opposite examples and they are the ones who give you the strength to never throw in the towel, ”explains the specialist
Recognize that the sick profile has been changing in recent months, he is much younger, from forty to sixty years, with ages accompanying them 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 from the outside. Suits, glasses, gloves, masks, more suits, disinfection, gel. Every day at every hour you should try to be alert to avoid possible contamination with the patient. This enormous handicap hampers something as essential as dealing with the sick directly. If you add measured contact with the patient to the bustle and setbacks, the connection is not always easy. However, with those with the longest stay, it is with those who reach a higher level of friendship. “Also with their families” says Maria. ‘Moreover, it is patients with whom you fought so many and so many days, which you notice more. You are involved in intubation, it unites us more with the patient. When you start talking to the awake patient, last moments are like this one, connect in that moment, feel his fear and try to encourage him. That moment binds you in a special way to the patient. Then, when they get home, they send you pictures or something to the hospital; it is priceless, it is the best reward. “
Maria acknowledges that The amazing level of unconsciousness he perceives even on the street in some cases never ceases to amaze him. She says she’s as surprised as she’s pissed off. “It’s a behavior derived from the lack of information. When someone close to me asks how I’m doing, I tell them they don’t know we live in hospitals. It’s the only way I can explain that lack of caution. Health resources are finite and can reach the point where respirators, medications, etc., are missing. Statistics and calculating certain ratios are misinterpreted, are data out of context they give peace of mind to the population, while on the other hand we have saturated ICs. Those indices give a false sense of calm. “
Maria hangs on the hook after talking for half an hour. He has been on call for more than 20 hours, a routine for her and her colleagues, doctors, nurses and nurses and assistants, a real ordeal for everyone. Remember it’s part of their job, that while there are things that continue to irritate him, this is not the time to waste time on these fruitless debates.