War medicine in the ICU of Rosell: “We do not see the end of this nightmare”

CARTAGENA. Work with a knot in the stomach almost continuously is not easy to cope with. The tension, discouragement, frustration, the prisas, the damn fever that does not go down, the endless prone maneuvers, the decompensation, the bitter taste that hammers the head for not being able to attend to this patient longer, the race against time from the first second you enter the ICU, that unbearable sound of the pager that does not let you take a breath, the patient’s face of fear, when telling him to intubate, the call to family… And, in the most serious cases, the death.

Coming home, a sigh, breathe and not stop thinking, now with the slump produced by a very intense guard, which is just one more day, another day in this damn battle against coronavirus, which nobody knew about less than a year ago and which has changed forever to assistants, nurses and doctors of our hospitalss.

The figures are discouraging, ICUs are about to collapse and the death list does not drop. We look at each time with less empathy the cold data of infected, hospitalized, entered in the FIA and deceased, as if it were one more number on yet another day of this endless, ungovernable and endless plague.

Those who fight it do not have time to see, analyze and interpret. Su day to day it is a parallel reality, a world infinitely far from ours, in which the life, the 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 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 has happened in this little less than a year is not comparable to anything. He recognizes that his day to day is difficult to explain, “exhausting” the level of accumulated tension is alarming, both at times and frustration at 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 increasingly growing number of cases. “The number of patients that we have in charge of intensive medicine is every day more and that makes us strenuous shifts” reports the intensivist to Murcia Plaza. Up to the point, they have to structurally surpass the ICU.

They have a limited number of beds in both Rosell and Santa Lucía (it seems obvious, but some have not realized it yet) (16 in Rosell and 27 in Santa Lucía), but the demand for care due to the issue of patients covid has made it necessary to enable a hospital area to attend critical patients where there has never been before. In this way, “it is very complicated both the day to day and the management of the guard”, underlines María. There are many patients in charge of the intensivist, with a volume of work that patients with this very high pathology incorporate when they undergo serious admission to the ICU, “he adds.

He recognizes that what he has been living for ten months he would not have imagined “not in the worst of my nightmares. If they told me a year ago I would not have given credit. Between us we talk about that this is from ‘war medicine’. We have had to learn to work differently. The critical patient needs brutal meticulousness. A single patient can take you hours on a watch, but the healthcare pressure to which we are subjected is also making us work in a different way, piecemeal, something with which we do not feel comfortable at all. “It generates a” tremendous discomfort “, “It is nerve-wracking not being able to dedicate more than necessary time to the patient who does need it”.

If the day to day is an almost endless long-distance race, think about what remains, With such horrible infection and death figures, 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 looking at the minute by minute.”

“It is very discouraging,” he acknowledges. “And we are looking for a way to cope. Every day I collapse several times and I compose myself many times. Guard ledges are complex. You are dejected, when you get home you feel the physical downturn, but the mood is not bad. Team work (nursing, assistants, intensivists) It is essential to avoid falling apart. Must tow the worst off at that moment. “

The intensivist explains that when a patient arrives at the ICU with severe pneumonia, his treatment lasts forever; the pathology is so serious that the improvement is very slow, so it can be thrown in the ICU for a month and a half or two months. “We have not come to notice downturn between waves”, He says. The ICUs were full because the covid patients returned in July “and we have not stopped. When you have the high incidence of the new wave, you have not gotten to discharge those of the previous one, which is why we have been overworked for many months now. “

Fatigue, isolation and fear

The patients arrive very scared at the hospital. The scary faces are evident because they are aware of their worsening. They arrive fatigued and put on a mask and then another with the richest oxygen. Later, the intensivist appears and tells them that they are going to go up to the ICU. “They are very afraid because they see a progression of the disease to the worse. In addition, If the worsening continues and we have to explain intubation to them, it is normal that fear paralyzes them: they nod their heads and little else, “adds María Galindo.

Patients arrive at the ICU in 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 are sick that you can’t always compensate. Hence, we have to make a prone maneuver (Put them face down, which is a way of working with the back of the lung, which usually improves oxygenation). This maneuver is very complex because the patient is sedated with tubes, lines, probes, etc …, which requires a team of several people and extreme precautions. There are patients who require them almost every day. “

But they have such a bad time in bed intubated as “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 that we see is the loneliness of the patient here and that of the family at home. “

This pathology requires isolation criteria, which prevents 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 isolation measures and, therefore “we go in to serve them less than we would like”. The patient receives encouragement, but is not accompanied continuously “which is what he would need. That 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 how the patient gets out of hand and that the table progresses refractory to all measures. That does not take away our desire 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

Acknowledge that the sick profile has been changing over the months, he is much younger, of forty to sixty years, with ages that accompany them because they do not have 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. Suits, glasses, gloves, masks, more suits, disinfection, gel. Every day at every hour you have to try to be alert to avoid possible contagion with the patient. This enormous handicap complicates something as essential as direct dealing with the sick. If you add measured contact with the patient to the rush and setbacks, the connection is not always easy. However, with those with the longest stay, it is with those who achieve a higher level of friendship. “Also with their families” says Maria. “In addition, they are patients with whom you have fought so much and for so many days, which marks you more. Intubation involves you, it unites us more with the patient. When you go in to talk with the awake patient, his last moments like this, you connect in that moment, feel his fear and try to encourage him. That moment binds you to the patient in a special way. Then they, when they are at home, send you photos or send you something to the hospital; that is priceless, it is the best reward. “

Maria acknowledges that The astonishing level of unconsciousness that he observes in some cases even on the street does not cease to amaze him. Says she’s as surprised as she is pissed off. “It is a behavior derived from the lack of information. When someone close to me asks me how I am, I tell him that they do not know the reality that we are living in hospitals. It is the only way that I can explain that lack of prudence. Health resources are finite and it may reach that point of missing respirators, medication, etc … Statistics and the way to calculate certain ratios are misinterpreted, are data out of context they give the population peace of mind, when, on the contrary, we have saturated ICUs. Those indices give a false sense of tranquility. “

Maria hangs up the phone after half an hour of conversation. 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 anyone. Remember that it is part of their job, that although there are things that continue to irritate him, this is not the time to waste time in these fruitless debates.

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