Sunday, June 13

The ICU after the covid storm

After intense, long, uncertain weeks of insecurity, exhaustion, loneliness, after hard, very hard weeks, the ICUs of almost all the Alicante hospitals are beginning to regain their normal activity these days after being “clean” of SARS-CoV 2. The storm subsides, with only five critical patients admitted throughout the province, after arriving at suddenly treating up to 258 at the peak of the third wave. The health workers admit to feeling relief, although it is difficult to find someone who does not end up shedding a tear when they recall everything they have experienced in the last fifteen months. Fear, anger, sadness, resignations, isolation, physical and mental fatigue, are some of the sensations that are repeated. But, above all of them, the feeling of pineapple, of a team prevails: “Without the union that has existed between all the colleagues, without the total dedication of each and every one, it would have been much more difficult to live all this”, Francis Martínez highlights , the supervisor of Intensive Care in the Marina Baixa.

Part of the team of the Intensive Care Unit of the Hospital de la Marina Baixa. | DAVID REVENGA

See the faces again

When crossing the threshold of the ICU of this health center, after going through the door that reads “Restricted access”, the first thing that is perceived is the serenity, the calm with which the staff unfolds. From August of last year until just a week ago There has not been a day in which doctors, nurses, assistants, orderlies or cleaning personnel did not have to wear PPE eagerly to access the patient boxes. Now, although many, many precautions are still being taken, the ritual of putting on a gown, gloves, goggles, a mask and more gloves has been temporarily put aside, allowing them to “see our faces with each other and with patients, something that we had lost a long time ago. In fact, when the covid seized all the beds in this unit, “there came a time when during the entire shift we were all wearing PPE and you did not even recognize your own colleagues,” they point out.

Although it may seem a little minor, this is one of the great changes that many health workers welcome from this “new normal” in the ICU. «Come to work without thinking that you will have to dress with all the equipment, without having to bring four or five sets of underwear from home to change all over, because when you come out of a box you come out soaked and you have to go straight to the shower, it is a liberation, explains nurse Pilar Seguer. Wounds and marks on the face due to the tightness of the masks or protective glasses are another of the characteristic marks that immediately identify those who work in the ICU, something that they now remember almost with laughter but that for months was a torture.

The Auxiliary Nursing Care technician Encarni Tello remembers the day the first ten “envelopes” with covid equipment arrived, the packages containing the PPE that they have used throughout this time. «For the week before, Francis would not stop telling us every day how we should dress, how to undress, that we had to practice in case the day came when we needed to use them, that it was done this way or the other, … But the coronavirus was still in China and it seemed so, so far away. Nobody imagined the one that was going to fall on us », says this assistant. Meanwhile, her companions explain how the chaos of the first days and the lack of initial material forced them to protect themselves with the first thing they found: garbage bags, goggles and diving caps, masks that came through donations … The staff has expanded, works were carried out to be able to go from 12 to 32 ICU beds, they have sent many devices and instruments, but we have also lacked many resources, materials and humans. And that is something that must also be told », highlight the interviewees.

The ICU after the covid storm


Suffer and care

Nurses, assistants and doctors now chat, smile, tell each other their things and recall in a relaxed way their experiences throughout this health crisis. They need to let it go, tell it all like a torrent. It is his particular emotional therapy. But this was not always the case. Not much less. “For weeks, there has only been silence and a lot of tension here. There were days when you went home and in the car you realized that you had practically not exchanged a word with your colleagues. We went to the pinion, because we had all the routines so mechanized, so much work and so many patients to carry out, that there was no time for more “, points out the TCAE Pilar Ruiz.

Their namesake Pilar Seguer remembers another day of deathly silence: the August afternoon when they were called to warn them that a critic was admitted to the ICU for covid-19, after more than a month “clean”. “It was as if a jug of cold water had been poured on us. Like going back to the starting point again, ”adds assistant Isabel Tárraga.

Suffer and care are the two verbs that best summarize how they have lived these months. “We have taken great care of the patients, but we have also taken great care of each other. There comes a time when you have the feeling that you lack eyes because you are constantly aware of everyone, that things are done well, not to make any mistakes and, above all, that emotionally we do not fall apart ». Nurse Gema Castell knows this well. He also knows what it is to suffer. Two of her colleagues on duty were infected in the first wave, within a few days of each other. It is something that no one has forgotten. “They got very sick and here we had a very bad time for them, many worried days, calling them at home and seeing that Pilar had moments when she could barely breathe,” she says while both their eyes get wet when they remember. Valentina Alfaro, the third in the group and who also experienced the rabies of the virus firsthand, ran to make a will after suspecting that she might be infected: «I had seen so much with our patients, so many outcomes, that I panicked and i thought i was going to die».

Two health workers are finally treating an ICU patient without PPE after being free of covid-19. | DAVID REVENGA R.PAGÉS

To get an idea of ​​the emotional impact that the coronavirus pandemic has had on all these workers, it is enough to point out that Tina, as her colleagues call her, was not the only one who went to a notary to register her last wishes believing that this would not come out. “I did too”, recognize several toilets of the unit.

They have also suffered for the patients. A lot of. For seeing them alone; when they went to intubate them and asked them if they would wake up again; when they came out of a bad shift and did not know if the next watch would find them all still alive; when they made video calls to their relatives and witnessed all the love and fear shared from a distance; to see that younger and younger patients were admitted; for perceiving the pain reflected in many faces. They remember the name or the stories of almost all of them: when “the taxi driver” took his first steps after being extubated; the lady who was video-conferred to speak with her son and a few hours later suddenly got worse and ended up dying; the young foreigner whose wife kept yelling at the phone “I love you, I love you.”

So that these personnel did not end up overcome by suffering, the two heads of the unit requested the intervention of the Hospital psychologists, who came to the ICU each shift for therapy and group sessions. Now, with the rainbow already shining above their heads, many still need that support.

Rage and not failure

“There are many people with post-traumatic stress, who have even had to ask to be discharged, because it is difficult for them to handle the situation,” explain José María Carrasco and Francis Martínez. Others continue at the foot of the canyon. And, although they want to savor the current moment of relative calm, they remember that in an Intensive Care Unit «you always work with a lot of pressure, with patients who come to us with very serious pathologies and with a higher mortality rate than in any other hospital service ». That is why no one lets their guard down.

Do you fear the day when the coronavirus returns to the ICU? They all agree that, unlike what happened in the second wave, they are now aware. They know that sooner or later they will have a covid patient again, because the virus is still lurking. “But now we would not receive it as a disappointment or failure, but rather with sadness, with anger, because we are very tired and we see that, despite everything, there are still people outside who do it badly.”

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