CARTAGENA. Work with a knot in your stomach almost continuously it is not easy to cope. tension, discouragement, frustration, hurry, damn fever that never goes down, endless predisposed maneuvers, decompensation, the bitter taste that hits your head because you can no longer assist this patient, the race against time from the first second you enter the ICU, that unbearable sound of the pager that does not let you breathe, that of the patient out of fear, when he tells her to intubate, call to family… And in the worst cases, death.
Come home, sigh, breathe and don’t stop thinking, now with the recession caused by a very intense guard, which is just one day, another day in this damn the coronavirus, about which no one knew less than a year ago and which has changed forever nurses, nurses and doctors in our hospitalss.
The numbers are daunting, ICUs are on the verge of collapse and the list of deaths is not dropping. We look every time with less empathy cold data of infected people, hospitalized, entered into the FIA Yes deceased, as if another number on another day of this endless, ungovernable and endless misfortune.
Those who fight against it do not have time to see, analyze and interpret. Sday by day It is a parallel reality, a world infinitely far from ours, in which life, thousands of lives, are played in a delicate game of chess, where every piece counts, every move, every decision and every strategy; nothing can be left to free will and is not always won.
Maria Galindo He has been an intensivist for 18 years. He worked in ICU in La Arrixaca and Santa LucíaTherefore, after so many years of experience in intensive care, what happened in this little less than a year is not comparable to anything. He admits that every day is hard to explain, “exhausting” the accumulated voltage level is alarming, both sometimes and the frustration of not being able to reach and assist everyone on time.
This week, he had to work at Rosell, in the ICU, allowed by the growing number of cases. “The number of patients we have to clean with intensive care is increasing every day and that makes us exhausting changes” reports the intensivist to Murcia Plaza. Up to this point it is so that it must structurally surpass the UCI.
They have a limited number of beds in both Rosell and Santa Lucia (it seems obvious, but some haven’t figured it out yet) (16 in Rosell and 27 in Santa Lucía), but the demand for care due to the problem of patients covid made it necessary for a hospital area to be assisted by critically ill patients where it had never existed before. In this way, “it is very complicated both the day and the management of the guard”, María emphasizes. There are many patients who care for the intensivist, with a workload that patients with this very high pathology incorporate when they are subjected to serious hospitalization in the ICU “, he adds.
He admits that he has not imagined what he has been living for ten months “Not in the worst of my nightmares. If he told me a year ago, I wouldn’t have given credit. We talk about it between us this comes from “war medicine”. We had to learn to work differently. The critical patient needs brutal meticulousness. Only one patient can take you hours to watch, but the medical pressure we are subjected to also makes us work in a different way, in pieces, something we don’t feel comfortable with at all. “It generates” extraordinary discomfort. ” “It’s nervous not to be able to dedicate more than necessary to the patient who needs it”.
If the day is an almost endless long-distance race, think about what’s left, With such horrible infections and fatalities, it is impossible and unhealthy. They prefer to do everything in the short term “so as not to collapse, because we do not see the end very clearly. We try to survive this by looking 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 compose myself many times. The guard edges are complex. You are depressed, when you get home you feel the physical fall, but the mood is not bad. Teamwork (healthcare, nurses, intensives) It is essential to avoid falling. Must the worst trailer of that moment. “
The intensivist explains that when a patient arrives at the ICU with severe pneumonia, his treatment lasts forever; the pathology is so severe that the improvement is very slow, so it can be thrown into the ICU for a month and a half or two months. “We have not come to notice the recession between the waves”, He says. ICUs were full because the patients with covid returned in July “and we didn’t stop. When you have the high incidence of the new wave, you failed to download the previous ones, which is why we have been overworked for several months. “
Fatigue, isolation and fear
patients arrive at the hospital very scared. scary faces are obvious because they are aware of their worsening. They arrive tired and wear a mask and then another with the richest oxygen. Later, the intensivist appears and tells them that he is going to go to the ICU. “They are very scared because they see an evolution of the disease in bad. In addition, If the aggravation continues and we have to explain their intubation, it is normal for fear to paralyze them: I nod and do something else, “adds María Galindo.
Patients go to the ICU in case of respiratory failure. She is a sick person who has a situation of respiratory failure with severe difficulty breathing. Blood oxygen decreases and must be intubated. “There are patients you can’t always compensate for. Therefore, we need to make a predisposed maneuver (put them face 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, lines, probes etc …, which requires a team of several people and extreme precautions. There are patients who need them almost every day. “
But they are so sick in the intubated bed as “Family anxiety is brutal, because not being able to visit them is a horrible feeling. Uncertainty and anxiety are extraordinary for them: the great pain we see is the loneliness of the patient here and the family at home. “
This pathology requires isolation criteria, which prevents the doctor and the patient may be close typical of a situation as serious as the one in which they live. It is not an open box because it requires protection and insulation measures and therefore “We come in to serve him less than we would like”. The patient receives encouragement, but is not constantly accompanied “that is what he would need. That emotional support is short-lived. “. 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 control and that the table progresses refractory to all measures. This does not take away our desire to work, because then there are opposite examples and they are the ones who give you the strength to never throw in the towel “, explains the specialist
Acknowledge that the patient’s profile has changed over the months, he is much younger, from forty to sixty years, with ages that accompany them because they do not have underlying pathologies and “who never throw in the towel”.
The connection with the patient is the other reward
The daily routine is complex seen from the outside. Suits, glasses, gloves, masks, several suits, disinfection, gel. Every day, every hour, you must try to be careful to avoid possible contagion with the patient. This enormous handicap complicates something as essential as the direct relationship with the sick. If you add measured contact with the patient in a hurry and counteract, 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. “In addition, there are patients with whom you have struggled so much and for so many days, which marks you more. Intubation involves you, unites us more with the patient. When you talk to the awake patient, his last moments like this, you connect at that moment, you feel his fear and you try to encourage him. That moment connects you to the patient in a special way. Then, when I’m home, they send you photos or send you to the hospital; that is invaluable, it is the best reward. “
Maria admits that The astonishing level of unconsciousness that he notices in some cases, even on the street, never ceases to amaze him.. She says she’s as surprised as she’s upset. “It is a behavior derived from the lack of information. When someone close to me asks me how I am, I tell them that I do not know the reality we live in hospitals. It is the only way I can explain this lack of caution. Health resources are finite and can reach that point of shortness of breath, medication, etc. The statistics and the calculation of certain reports are misinterpreted, are given out of context it gives peace of mind to the population, when, on the contrary, we have a saturated ICU. These clues give a false sense of peace. “
Maria hangs up after half an hour of conversation. He has been on duty for more than 20 hours, a routine for her and her colleagues, doctors, nurses and nurses, a real ordeal for anyone. Remember it’s part of their job, that, although there are things that still irritate him, it is not the time to waste time in these fruitless debates.