News "The risk is to miss other pathologies"

“The risk is to miss other pathologies”

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IThey work in hospitals or in town medicine, they are generalists, nurses, emergency doctors or midwives: around fifteen caregivers, on the front line against the Covid-19 pandemic, have agreed to tell us about their professional daily lives. Every day, in this “crisis diary”, The world publishes a selection of testimonies from these “white coats”.

“It is becoming necessary to quickly take care of the patients whom we had until now shifted”

François Cornelis, 42, hospital doctor, radiologist at Tenon hospital (Paris 20e)

François Cornelis, hospital doctor, radiologist at Tenon Hospital in Paris. Photo: François Cornelis

“An unstable balance is being established in the hospital. On the one hand, we are devoting all our energy to Covid-19, which is absolutely essential and seems to be bearing fruit, but, on the other hand, it is becoming necessary to quickly take charge of the patients that we had until now staggered.

“Some patients, especially in oncology, contact us for situations that have now become urgent”

Indeed, some patients, especially in oncology, contact us for situations that have now become urgent, such as pain management or simply the biopsies necessary for the implementation of treatments. To carry this out, surprisingly enough, we are forced to adopt a very artisanal and therefore very time-consuming approach, because our means are considerably limited.

The services are weakened in their usual functioning, each one takes charge of the task and progresses step by step in the meanders of the current relative hospital disorganization. It is necessary to negotiate everything: the caregivers available for the intervention, hospitalization in a non-Covid-19 service and sometimes having nothing to do with the pathology presented by the patient, the anesthesia whose resources were in largely reassigned to Covid, the equipment to finally carry out the procedure which is often difficult to order and even more to receive. And, of course, on D-Day, we are not immune to cancellation if the patient ever becomes Covid-19 or in an even more urgent emergency.

But the hospital is resilient and we always find a solution between us. This solidarity is essential in order to project ourselves into the future so that we can continue to carry out our mission for the common good on a daily basis, even modestly in certain situations. “

“The main thing, to manage the crisis, is not the macabre count of the dead, but the number of beds available”

Mathias Wargon, 53, chief of emergencies at Delafontaine hospital, in Saint-Denis (Seine-Saint-Denis)

“Could it be because the illness kept me away from the hospital for more than a week?” When I returned on Monday, I found the day a little quieter. We felt a kind of breath. There were even a few smiles behind the masks of the nurses. A simple break or the announcement of the descent? It is far too early to tell.

Mathias Wargon, chief of emergencies at Delafontaine hospital in Saint-Denis (Seine-Saint-Denis)
Mathias Wargon, head of emergency at Delafontaine hospital in Saint-Denis (Seine-Saint-Denis) MATHIAS WARGON

We must be wary of mortality figures. This weekend, they slowed down and on Monday they started to rise again. Counting the dead on a daily basis is a bit morbid. This feeds the debates between pseudo-experts, we get excited about variations of 5% or 10%, but that doesn’t mean anything. The variability from day to day is enormous. On Sunday, the data goes back less well, for example. In the hospital, we come to know, but in the Ehpad, how to distinguish with certainty the deaths due to the Covid from the others? And the deaths at home, who keeps the accounts?

“We see that the number of infarctions or strokes has dropped, that there are more places in neurology”

To assess the burden of a disease, it is necessary to measure the excess mortality. However, to achieve this, you need to step back. We’ll know in a month or two. With the heat wave of 2003, we realized that, admittedly, there had been many deaths at once, but that in the end the increase in mortality had not been so impressive. With the Covid-19, there is an excess mortality. There are a lot of deaths, it’s dramatic. But, for us, the main thing to manage the crisis is not this macabre daily count, but the number of beds available.

In the emergency room yesterday morning, we still had to transfer five patients to other establishments in Ile-de-France, due to lack of space. In a crisis meeting, I insisted: despite this “breathing”, you should not relax. And we should not miss out on other pathologies either. Because focusing on the Covid-19 side of the patients is the risk. We can see that the number of infarctions or strokes has dropped, that there are more places in neurology. So many potential deaths that do not appear in this daily morbid count. “

“I see more and more people outside … today I am resigned”

Ophélie Mauger, 25, nurse at the Nantes University Hospital (Loire-Atlantique)

“The staff are in a kind of disillusionment: one has the impression that this wave, it will never come, while fearing it. The CHU has anticipated human resources well. We know that there are people at home who can be called at any time, the services have been opened upstream, so for now we always have services ready to welcome new patients, it’s quite comfortable and reassuring.

Ophélie Mauger, nurse at Nantes University Hospital
Ophélie Mauger, nurse at Nantes University Hospital Photo: Ophélie Mauger

I find caregivers less anxious than a few weeks ago, when there was a vagueness about the situation. Now, things arise, the climate is more serene. But every day, we are told again: “Today is calm, but maybe this afternoon will happen, be ready.”

“Sometimes we hear it said:” In small towns, this is not going to happen to us “or:” I am so old, so it doesn’t matter if I have it “”

I see more and more people on the street. When I go to work, I meet families who go for a walk, young people who have fun in skateparks. I live next to a major road and, there too, traffic has increased.

Sometimes we hear it said: “In small towns, this is not going to happen to us” or: “Me, I’m so old, so it doesn’t matter if I have it”. While if it is serious, we cannot know how our body will react, and then, above all, during this time, we infect others. I have been working with the Covid-19 for over a month, at the beginning I was very angry when I saw all these behaviors, today I am resigned.

And then, there is a point where containment is going to be stopped, somehow, people are going to get back in touch with each other. There, I fear a new rise in cases and, surely, a new containment. “

“We imagine the transferred patients surprised to see when they wake up the sun from here”

Julie Oudet, 39, emergency doctor at SAMU Toulouse (Haute-Garonne)

“For the past few days, I have been on regulation at SAMU and SMUR. Teams have dispatched patients who arrived by air to our hospitals. Sometimes we have transfers that come from far away, but never so much. Staff return specifically to carry them out, in addition to the usual teams.

Julie Oudet, emergency doctor at SAMU Toulouse (Haute-Garonne)
Julie Oudet, emergency doctor at SAMU Toulouse (Haute-Garonne) JULIE OUDET

“We are there to be useful to patients, whether they say chocolatine or not!” We were joking with colleagues! “

On both sides, it is a Dantesque organization. A priori, it went well. Everyone works a lot more than usual, but we have a great planning management team.

We have enough beds for the sick in the region, so we can accommodate them elsewhere. We have a lot of patients in intensive care, but we also have the first patients who are better and who are starting to come out of the intensive care unit. We are not in a situation of great difficulty as in other regions.

And it’s our pleasure to support them, for sure. We are there to be useful to patients, whether they say “chocolateine” or not! We were joking with colleagues! We can imagine them, when they are going well, be surprised to see the sun coming up from here. “

“Pathologies will worsen, because they will have been less followed”

Pierre Loisel, 59, caregiver, hospital group in South Brittany, Lorient (Morbihan)

“We welcomed nine patients from the Paris region on Sunday. Everyone was ready, the organization was exemplary. And it is not unthinkable that we can take more, here in Lorient.

Pierre Loisel, caregiver, hospital group Bretagne Sud, Lorient (Morbihan)
Pierre Loisel, caregiver, hospital group Bretagne Sud, Lorient (Morbihan) Photo: Pierre Loisel

At the moment, there are enough people and no (yet) need for additional staff. But you have to be aware that this is due to a very significant decrease in the rest of the activities. Afterwards, with an intense resumption of cardio, gastrointestinal interventions, etc., there will be tired caregivers, not to mention the time off that has been postponed, and we will surely be on the eve of the summer holidays.

“The distress is increasing, especially in the Ehpad. Many people on staff testify to an infected parent “

Pathologies will have worsened, because they will have been less followed. Doctors’ offices have been deserted. This will require staff who are available and in good shape.

The distress is increasing, especially in the Ehpad. Many people on staff testify of an infected parent. I lost two comrades, who were treated in oncology. They did not die, a priori, of the Covid-19, but that adds to the heaviness of the moment. Deaths must have increased significantly; I see him since last week in The Telegram, with a full page of obituaries.

The hospital always asks me to be ready. I was contacted by the health reserve to go to Mulhouse or overseas. I talked about it with my wife, but I know it can start strong here. And I would regret having left and not being able to intervene in the Lorient sector. At the end of the containment, there will surely be another peak, I hope less intense. It’s not all over, far from it. “

Find all the previous episodes of the “White Coat Crisis Journal” here.

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