A French ICU in Epidemic


Life-long pain in 24 hours: a French ICU in epidemic

By LORI HINNANT

November 17, 2020 GMT

Marseille, France (AP) – Four more calls to go, each with careful words, painful silence.

It is 2 pm in the intensive care ward of La Timon Hospital in Marseille, and Drs. Julian Carvelli is calling on families affected by the second wave of coronovirus with news about their children, husbands, wives. With intensive care wards in France with more than 95% capacity for 10 days, Caravelli makes at least eight difficult calls a day.

In Marseille, this wave is bringing even more people into the ICU than the earlier ones in spring, with many in more serious condition. Caravelli warned a father that his son may need to be put into a coma.

“At the moment, he is holding. But it’s true that – I don’t know if you’ve already been told – his respiratory condition is worrisome, “Carvelli admits. There is a long stop at the other end.

“Listen, do your best,” finally comes the tense answer.

France is two weeks into its own coronovirus lockdown, known as “Le Confinement”. Journalists in the Associated Press spent 24 hours with the intensive care team at La Timon, southern France’s largest hospital, as they struggled to keep a bed open For the influx of patients.

The doctors and nurses tell themselves and each other that they have yet to catch up. Government high-end show infections may have reached their second-wave high point, and are hospitalized Last weekend for the first time since September.

But medical staff are also disappointed that France did not prepare More in the months following the first wave. And when doctors and nurses were seen as heroes, this time is different.

“Earlier, they used to applaud every night. Now they tell us that it is doing our job, ”said 23-year-old nurse Chloe Gescon, who has spent half of her 18-month career under the shadow of coronovirus. There is more than a trace of bitterness in his voice.

Marseille has been steeped in coronovirus cases since September. The port city, off the Mediterranean coast of France, had the worst effect of the virus last spring, killing only with a vengeance. Wound down as summer vacation. Bars and restaurants across the city closed on September 27, a month before the nationwide closure. It was not enough.

A decade of budget cuts left France with half the number of intensive care beds this year, when they needed it most. By the time the first imprisonment ended on 11 May, more than 26,000 people had died in France. The government promised to take advantage of the expected heat loss to add beds and train reinforcements.

That was the time of acting when new infections were at their low point, said Stephen Griffin, a virologist at the University of Leeds.

“It was always bubbling under the surface,” he said.

But it was only in the early fall that work began on the reopening of an acute care wing in La Timon, which was less open two weeks ago and still has exposed wires and a fiberboard barricade with duct tape. The promised reinforcements are slow to arrive as well, and any training they receive is in the moment, as Pauline Rainier is learning during her first week as an ICU nurse.

Compared to the emergency room, the ICU is a relatively quiet place with moments of urgency when the patient needs more oxygen or intervention. Beeping is calmed by the machines’ frequent soundtracks. There is no good news here; The best news is that a patient is stable enough to move elsewhere.

When the 12-hour nursing shift begins at 7 am, all 16 beds are filled with COVID-19 patients, and five are conscious. For those in an artificial coma, an hour and at least two people take time to wash and then fold each into their beds, taking into account the wires and plastic tubing.

This is Rainier’s first act.

She helped a regular coronavirus ward during the first wave and offered a summer retreat for intensive care. Instead, the 26-year-old was sent back to cardiology, filling patients with postponement of heart surgery.. The second lockdown occurred just a week after the ICCU was notified of a national holiday on 11 November.

This is Rainier’s second inning as a reinforcement of the ICU. Her new colleagues barely knew her name and gave very little time to teach. The daughter of a nurse who works at La Timon, she learns by watching to a large extent.

It takes months to be trained as an intensive care nurse, Can be experienced for years in the specialty of withstanding death in the bay.

This virus is even more demanding than the usual urgent challenges. Caregivers take almost as much risk for the patient, and accordingly, every time they enter a room, dress. And so going to bed means planning multiple tasks at once: washing, toothbrushing, examining vitals, replacing IV drips and, finally, turning them over to help the patient breathe.

Rainier pulls on a long-sleeved apron above the scrub with a quick twist of the wrist to knot on the neck. Then a pair of gloves. To secure the glove, punch a thumbhole through the underside of the sleeve, then pull on a second pair of gloves. Head covering, goggles and finally, a second apron in plastic. X-ray technicians wear a third set of gloves to handle the plates. Doctors performing an intubation or other major procedure wear a plastic face shield over the goggles.

For each person inside the room, someone stands outside handing out anything they need and helps to close the strip and release protective gear at the end. Every gesture takes on external importance.

Mid-morning, the man in Room 6 makes enough improvements to go into acute care. At the same time, doctors discover that room 11 in the mookshift ward is not equipped for a dialysis machine that the unconscious patient now urgently needs. He would have to be moved to the main ICU throughout the hall.

Doctors and nurses snatched aprons, gloves and goggles out of the carriage to get themselves out.

It is about 25 meters (yards) away – a quick left, through two sets of double doors, past the break room and work center. Carrying a 60-year-old man eventually requires 14 medical personnel, 45 minutes of preparation – including hooking him to a portable oxygen generator that must be disinfected later.

They start shaking the bed at 10:40 am. It takes them 15 minutes to maneuver in a room position. Sweat repels Rainier’s light blue scrub.

Storm Room 12, a cleaning crew, fills it with the smell of bleach: a bed is now free.

It is 1:30 in the afternoon and many nurses are in the breakroom with no windows. Doctors have converged from outside, in Room 9. The 54-year-old man was alert in the morning, but his oxygen levels kept dropping, and the time had come to seduce and penetrate him.

Again, doctors and nurses converged, three people inside and three people outside the room to bring tubing, scissors, bandages. The doctor replaces an IV in the man’s right hand and, after an hour, covers his torso with a sheet. Now, four out of all 16 coronavirus patients are in artificial coma.

“As long as their bodies can be healed, we have to help them hold on,” says Carvelli. “But intensive care is a terrible thing in itself. Not everyone can save it. “

This is not what he tells families during the half-hour or so he calls them each day. Each call ends in minutes.

“We have to be convinced and at the same time tell the truth. It is a balance that is sometimes difficult to find, ”Caravelli says quietly.

The very deep cloud has a silver layer: Around this time, doctors have learned enough about the disease that they know when a patient is about to die and can call families to the ICU. This is what happened in La Timon last week.

During the daily call, families ask about the most recent coronovirus test – patients are tested three times each week – about oxygen levels, sedatives.

“You know, even if he tests negative, it doesn’t mean that he will recover more quickly,” Carvali gently told the daughter of a man in the ICU for four days. “No, it’s just that if she doesn’t have COVID, that’s one less thing,” she replies.

The man is still positive, but Caravelli tells him that he is sane.

“Can you tell her that we are here and we support her?” He asked.

“Of course.”

His voice broke as he said goodbye.

This disease is also affecting the employees. No doctors and only a few nurses have been infected in La Timon, but they are exhausted.

At 4:30 pm, two hospital managers came down to boost morale. Marie-Laure Satta, one of the 37 nurses, confronts them testily, with Rainier looking slightly lost on her side. The younger woman has just learned that she will return to the ICU for at least the next few weeks, and she is relieved and worried.

Reinforcement needs investigators, written instructions, something concrete to guide them, so that they can help regular employees, not burdens, emotion says, their entire body is stressed with emotion.

“I’m talking about well-meaning people, who are here to help, who just need a little recollection,” she blinks. “We need some rest.”

Managers understand, but it is unclear how much control they can have. The conversation ends amicably and they exit the ICU.

Sutt said after him, “Good luck to you too, because you are not in a better position than us.”

Like all of La Timon’s carers, Speculator is completely dedicated during the biggest medical crisis of his generation. But she becomes somewhat less stressful after this stress is over, perhaps helping to arrange an organ transplant.

Her husband works in a night shift at ICU and her two children are in preschool. Neighbors help with childcare intervals, which occur in the morning and late afternoon. She believes the government’s promises are empty.

“They serve interests other than hospital work and going. I’ve never seen that for either patients or carers,” she says when the mood calms down. “With the capacity of France, All the money in France …. They talk to us about savings – where does all that money go? “

Marseille was once one of the richest cities in the world, its natural harbor is an international hub dating back to 600 BCE and was founded by the focus of Greece. The city is in a waterfront depression inhabited by limestone hills, with La Timon almost colliding with its central axis.

Many historians believe that the first wave of black plague in Europe originated in the port of Marseille. The last major plague outbreak of the continent in 1720 killed half the city’s population. Local school children visited the Froul Islands, 4 kilometers from the coast, and the playgripital Caroline, who looks after the sailors with the plague.

“Everything we are doing now will be studied in history, because it is extraordinary,” Rainier told his new colleagues.

By now, the day’s shift is almost over. The bed in room 12 is still free, and the physicians overseeing the night shift expect it to be in reserve, just to keep it a little sluggish in the overload health system.

“I want to have a bullet in my Chamber,” Dr. Other hospitals are asked about open beds by phone, says Fouad Bojana. Calls to La Timon’s emergency room, demanding space for a man, COVID positive. Bojana asks him to run more tests and call back.

The ICU does not accept everyone; Doctors learned in the first wave that coronovirus patients needed a certain base level of strength and health to make it to recover.

That night, Buzana turns away two coronovirus patients, leaving them feeling too elderly and weak for intensive care. They will continue to be next door in hopes of improving their condition. They will later review the decision with doctors. But he is a little suspicious.

“We discuss it together. If one of us wants to take a patient and the other does not, we always take the patient. “We generally agree.”

At 2 o’clock, the emergency room man is admitted to the last remaining bed.

La Timon is full again.

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