In this article, Macarena Piñeda delivers a raw account of the work she must do on a daily basis to try to save her decompensated patients and, if not, the grueling post-mortem task she contemplates.
We were used to having critical patients, but the pandemic flipped 180 degrees.
Covid-19 is a very treacherous disease. You never know how patients are going to react and, from one minute to the next, they can be decompensating.
There is no doubt that second wave has been much worse than the first. I don’t know if patients are getting late or the bug is being more virulent, more catastrophic, but they’re having very bad tests.
Macareña Piñeda
Normally, I have three patients in charge. Every two hours, I have to change their position. The workload has gone up too much.
We don’t even have time to go to the bathroom, for breakfast or lunch. I can have lunch just at 5pm. It’s just that the severity of moving a covid patient is very high, and if you stop looking at it, it may break down from one second to the next.
Suddenly we have four deceased, one after the other, with simultaneous stoppages, tubings… Doctors and nurses have to split up. That’s something that didn’t happen regularly before. Now you have to arrive with a higher energy because if not, it doesn’t give you to work 24 hours.
Patients with covid are proning (face down), then it is very difficult to treat them. It requires a lot of staff, having six eyes on the monitor and six eyes on the patient. If he goes unemployed, you have to turn him over for a massage.
We always have to be prepared for the worst.
While we are more familiar with death, the process that one has to do post mortem in the case of covid-19 it is very chaotic, very sad.
Introducing a patient into a mortuary bag is the most shocking thing I’ve done in my six-year career.
You put it in the bag and that patient doesn’t get out of there anymore. He goes with his name on top of this bag to pathological anatomy and from there straight to the coffin. And it doesn’t open anymore, it seals, and his relatives didn’t see his face anymore.
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That’s terrible for me. It’s very distressing, sad everywhere.
We have to contain people outside the hospital. They beg you to come in so they can hug their dead relatives. And what else would I give to say yes. But unfortunately I can’t. Protocol doesn’t allow it. That’s the most distressing thing about the process.
In the end, you’re the one who has to mourn the patient., touch it, read letters to you, or show you audios as your family members wake up through a door.
And there are people who need to say goodbye, who have to go through the process of seeing it; it’s part of his duel. I’d love to help you, but I can’t.
A close relationship
When a patient is serious, I try not to part with him. No one would want to die alone, so I’m not moving on their side.
I give them the hand, I make them love, I like that they feel a presence next door. I think maybe I’ll help them die calmer.
That you’re sick having given it your all is very frustrating. Because in addition, many times that patient was stable for a good while and suddenly decompensating.
Everyone says to you, ‘Well, but it’s part of your job,’ but no one knows what it’s like to really be inside that room and see when you die a patient after you’ve done everything to save it.
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We, the nurses, are the ones who know the patient the most; how he behaves, what really does him well, what position the patient decomposes in. And you know all that because you spend all day in front of him.
We have a commitment to them; We wash their hair, we cure their injuries. It’s a very enriching job.
Sometimes, you see that the patient’s tests get worse and you have to say, ‘Hey, you know what, your tests aren’t going well, we’re going to have to intubate, you’re not breathing the right way.’ And many feel perfect.
At that moment, young people are the ones who feel the most fear, perhaps because they feel the farthest death.
There are those who write letters, try to record videos or send audio to family members… because it’s so complicated to promise that patient that he’s going to wake up again, they’d rather start saying goodbye.
This virus is so treacherous, you don’t know anything. NeitherWe have that certainty.
delirium
After a long sedation, there are some sick people who have a harder time coming back. Usually patients covid-19 must be intubated so that air reaches their lungs, which makes the process to wake them up even harder.
Even certain people may experience the delirium disorder, a state of mental disturbance that causes confusion and unease.
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Patients with delirium sthey think everyone’s against them.
They bite the tube, they try to get it out, it’s complicated. They are super aggressive and many times we have to try to calm them down among several. Because containing a patient who measures 1.80 centimeters and weighs 100 kilos is not easy.
We say, ‘Look, sir, you’re hospitalized, we’re waking you up, calm down, we want to get this tube out of your mouth, we know your throat hurts. But if it stays that way, we’re going to have to sedate again and back off.’
But un delirium patient doesn’t listen to you much. Unfortunately, it often has to be passed on to the pharmacological thing because they fail to understand. And there the meds help to have a calmer awakening.
A lonely struggle
I’m tired. We’re all tired. I don’t see or read news anymore.
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Because every day is the same thing: that cases increased, that the worst is coming. And I’m living it, so why am I going to keep watching news? I’d rather not, for mental health.
I don’t understand the people who organize clandestine parties or skip the curfew.
To these people, I say: maybe you want to hang out with your friends, but I’ve seen families hospitalized, moms losing their children. They think it’s not going to happen to them, but it happens, and a lot happens. There are young people who kill their grandparents, kill their parents just because they want to spend some time with their friends.
Many think this is a game, but I’d love to invite you one day to see how the disease behaves so they have a little more respect for him.
Covid-19 has highlighted inequality, both in the health system and in people’s daily lives. We know that the humblest, the poorest people, are the ones who are losing the battle in this pandemic.
The rich get richer and the poor get poorer. And I know there are people who need to work and take to the streets. Then I understand them. What I don’t understand is skipping curfew, throwing clandestine parties.
I think there are some super unconscious ones. And it’s minimal effort; other than, we’re never going to be able to get out of this pandemic.
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