Doctors and nurses in the corona crisis
They fight the virus every day. How do you experience this new everyday life? Through the week with an operating room nurse, a nurse and a family doctor.
The number of people infected with corona is increasing, and with it the number of seriously ill people. Doctors and nurses fight the virus every day. How do you experience this new everyday life? We asked an operating room nurse from Munich, an intensive care nurse from the Rhein-Main area and a family doctor from Berlin to give us an insight into their week.
The surgical nurse: She is 60 years old and has worked as a surgical nurse for 30 years, currently in a Munich clinic. She wants to remain anonymous so that she can speak more freely.
The intensive care: He is 58 years old and has been working as an intensive care nurse for 35 years, currently in an intensive care unit of a university hospital in the Rhine-Main area. He wants to remain anonymous so that he can speak more freely.
The family doctor: Stefan Karakaya, 45, is a family doctor in Berlin-Neukölln. Before his practice on the ground floor, he parked an old caravan as a new branch. Karakaya is cutting back on corona tests.
The operating room nurse sent her entries via WhatsApp, the other texts were written from phone calls.
Sunday, March 29, 2020
Confirmed corona cases according to the Robert Koch Institute throughout Germany: 52,547
The surgical nurse: Today was a normal weekend workday of 11 hours. The morning was calm, a caesarean section at 11.30 am; Mother and child well. Many discussions with colleagues about how the next few weeks will be. Then suddenly a registration: old woman with intestinal obstruction and suspected Covid 19. In my mind's eye, the process unwinds with all security measures. I notice a certain nervousness despite the preparation.
Unfortunately, it takes a long time to get started, since some of those involved do not know exactly how to behave. I assumed that the processes in all departments had been communicated. Probably not, or the routine is missing. The patient is seriously ill. After an hour, during the operation, the call comes with the test result: negative, isolation, relief! The patient is operated on successfully. Then another child with appendicitis. This patient also leaves the operating room safely. All in all a good day. Nevertheless, fear hovers over everything: How bad will it get? Will the material be enough? What happens when the intensive care units fill up?
Monday, March 30, 2020
Confirmed cases across Germany: 57,298
The family doctor: From 7 a.m. I was in my practice in Berlin-Neukölln. I looked at laboratory results, did paperwork. The normal patients come to the practice from 8 a.m.
At 10 a.m. I am out in the caravan. I started the heater first. I put on my protective clothing, plastic overalls, mask and glasses. I examine everyone who has an infection or a fever of unknown origin there.
The patients are spread out on the sidewalk, they are far apart, that looks strange. I call them into the car, they take a seat in the sitting area. We talk, then I decide whether to examine or just smear. I can listen to the lungs, measure fever, the level of oxygen in the blood, a complete examination, just lying down is not possible, it is too narrow for that.
There were 24 people there today. One had tonsillitis. There was nothing at another – except worry. I made a total of 20 smears and sent them to the laboratory. I always get the results the next day.
I've had the caravan for five years. It is original 60s, also inside. We went with the family to Brittany on a campsite on the Atlantic. During one of the vacations I got stuck on a stone and the back wall opened. That's why the car has only been standing around for a while. I had almost forgotten him. Now it has a new function.
I'm not afraid of Corona. I'm assuming that sooner or later we'll all get caught and hopefully we'll have enough immunity. It is clear to me that I am a potential risk for my family. But I don't worry much about it, neither does my ex-wife. Because, according to everything you know, children hardly get it. You have to prevent them from being carriers. So it is good that they are staying at home at the moment.
The intensive care: I have a night shift today. I've had the last two days off, so I don't know exactly what to expect – but I don't worry about that either. In my job, you have to be convinced that with the right equipment you can protect yourself from infectious diseases. And the way we work for Covid patients is no different from the influenza patients we have every year.
Last week we saw nurses and nurses from the Intermediate Care department to see how we work. IMC is an intermediate thing between intensive care and normal ward. These are people who may be able to help us out when the going gets tough. They've also sucked out a lung – you can't just learn that on the side. Now when I hear that medical students could also work with us in the fifth semester, I have to say: this is out of touch with the world. They might empty bedpans, but there are no bedpans for intubated patients. In an emergency, someone would just stand around in the way.
The surgical nurse: Today I had a compensation day for yesterday. I could sleep in there. Then wash your clothes, iron and cook for tomorrow. A friend of mine also lives alone. We went for a walk at a distance. That was nice. Sometimes people now clap on their balconies. I find this appreciation nice. I don't manage to go out on the streets with the steel workers in everyday life – but maybe there will be a few more people at the next care demo who will support us. In the end, I will measure the politicians by what they have done for us, not my neighbors.
Tuesday, March 31, 2020
Confirmed cases across Germany: 61,913
The surgical nurse: Now the lack of material has also arrived with us. We are strongly encouraged to use MNS, FFP2 and FFP3 masks very sparingly. We are looking for solutions for alternative face protection and try to make something that also protects the mouth and nose. I was busy with that for two hours today, which is not yet optimal, but we still have masks – how long? Another OP registration with suspected Covid 19, again a lot of communication is required. Who has to follow which rules?
After work I was still at my bookstore, you can order by phone. Now look for a few nice books and let’s go. This shop shouldn't go bankrupt, I'm so glad that there is around the corner.
The family doctor: I received an email, allegedly new protective equipment has arrived at the Association of Statutory Health Insurance Physicians. So I sent two employees there at 8 a.m. We already wash the normal mouth-nose protection. I could also use plastic overalls. I only have three of them in their original packaging, actually you should only use them once.
Unfortunately, the employees were at the KV for free: You have to show a written notification. We don't have them yet, so they're back without any stuff.
It was pretty busy with us today. I looked after patients in the practice, my colleague took the drawbacks in the caravan, 17 in total.
What bothered me today are discussions with my colleagues. I am in several chat groups, we send us specialist articles. Most of the distributors are behind government measures. But there are also some who ask if Corona really is anything other than flu. It is also important for me to sort myself: what is correct and what is not? The patients want to hear from me if everything is correct, they are afraid.
I do believe that the measures are correct. But you don't know how many people really die from Covid-19, there aren't enough numbers for that yet.
The intensive care: My service was very quiet tonight. We had two Covid patients, five of eleven beds in the ward are currently occupied. We are four people on the night shift. What laypersons cannot imagine so well: If you have a patient on intensive care who has several problems, you have to deal with it practically all night alone. In the case of a Covid patient who needs ventilation, the lungs have to be suctioned regularly. Most of them have circulatory problems, so they have to be given circulatory agents – this has to be constantly monitored. Many also have kidney failure, so dialysis is performed. You already have work to do.
Wednesday, April 1, 2020
Confirmed cases across Germany: 67,366
The family doctor: Of the 20 smears on Monday, 5 were positive, of 17 on Tuesday 4. In the past week there were often only positive results, times 3 when people were in the same pub.
The people who come are a little sicker than last week. What I also find: Those who complain about shortness of breath and not much else often have a positive result. At the beginning I didn't take it seriously as a symptom because you can talk yourself into shortness of breath. Now I'm paying more attention to it.
I was very happy today that all normal patients came to their appointments. About half stayed away last. This is an economic problem for me, my sales collapse. On the one hand I have to make sure that as few as possible come because of the infection, on the other hand I also need patients – and those with chronic illnesses have to be looked at every quarter.
I don't yet know what damage I have, so I don't know whether to apply for compensation.
Today I tried to start a video consultation, but I haven't been able to do it technically. I failed to log in, my data was incorrect, that was frustrating.
The surgical nurse: The morning meetings get longer every morning, there is more and more new information about procedures and new rules. Volunteers were sought who could be trained to work on the Corona Intensive. Three came forward, one said that they are not being properly trained because their colleagues are overwhelmed. They now have more work than usual, and we simply cannot see the overall situation.
The surgical program today is quite full and demanding. I have to go through a complicated intervertebral disc surgery, which I haven't had in a long time. The special concentration is good because it distracts from the other worries. After the lunch break, a caesarean section should come, but hardly anything is prepared, program change: postoperative bleeding in a patient with a coagulation disorder! So pace! Ultimately, that too works well. I'm done on the way home!
In the evening a video call with my nephew and his little daughter: I find out what is being read, I see a dream catcher I made myself. That feels good.
The intensive care: There was a lot more going on tonight. We now have four Covid patients, ten of eleven beds are currently occupied in the ward. Actually, 1: 2 care applies to us, one nurse takes care of two patients. This rule has been lifted by the clinic management, it will not be sustainable.
A colleague failed to suspect Covid, we got a replacement at short notice – that was lucky. Otherwise there would only have been three of us on the station tonight.
On our ward there are two rooms with a lock in front of where you can put on your protective clothing – smock, hood, gloves, safety glasses, FFP2 mask. With four Covid patients, two are already in rooms without a lock, so you have to change in the room. It may take three minutes to put on protective clothing. If it's an emergency, it's quicker. Then you can't disinfect your hands for 30 seconds, that's not in it.
For the next few days, I expect it to be even more stressful. It is usually like this: the workload increases, the staff decreases. Some stay at home because they are sick – some because it becomes too stressful for them. There are always 15 to 20 percent of such colleagues.
Thursday, April 2, 2020
Confirmed cases across Germany: 73,522
The intensive care: The shift was exhausting. The number of Covid patients remained the same, but we had three new arrivals with other diseases during the night – including one multimorbid patient. I had to put a catheter and he needed a blood wash, so the hours go by quickly.
Visits are prohibited throughout the clinic, but if someone is dying, one or two relatives can come. I think we will allow that to happen to Covid patients too. We would explain to the family member exactly how the protective clothing is put on and what can and can not be done in the room.
For us, dying is part of everyday life. If someone is 80 years old and he doesn't make it, then he has lived his life – so what? It is different with young mothers or fathers, it is close to you, although you should leave it at work.
The clinic is only paid for a patient until the documented time of death. After that, each dead person stays in the ward for two hours and is then examined again by a doctor – to be absolutely sure. Then the employees of a funeral home come and bring the dead person to our pathology. The body is picked up the next day.
The surgical nurse: I woke up relatively early today, I am often sleepless at the moment. That's why I feel tired. As always, our early discussion is a never ending story, there is always new information. What is the state of affairs, how many Covid patients are in our hospital? Many colleagues need this appointment to speak to them there; that's incredibly important.
Otherwise, the mood is not bad, we have enough to do. One patient was stressed for a short time, but then everything worked out. Sometimes I notice that the concentration decreases – with me, but also with colleagues. We then talk about it being difficult for everyone. Some are really bubbling out, this exchange is good for you.
It is now clear that colleagues should be parked for the new intensive care unit. The recovery room is prepared in such a way that it can become a complete corona intensive care unit with 8 beds – without additional staff, so this will be done by anesthesia nurses and nurses by the intensive care unit, who could in some way be unnecessary. We surgical staff will then take over some of the anesthetic care activities.
My feeling is that it is progressing, something is rolling. Of course you would like it to go faster so that you can cope with the possible rush of the seriously ill. But yes, there is hope that the crisis will be dealt with and that it may not be the absolute worst-case scenario as in Italy.
The family doctor: I had to take the youngest to school today, to emergency care. It was no different. Otherwise there is only another boy in emergency care, his parents are police officers, sometimes two older girls come. At home he always says that he doesn't want to go, but he likes it there.
In practice we made 13 corona smears. There is a certain routine now. In any case, it no longer seems so unusual to me how people stand on the sidewalk in front of my caravan. The patients are really nice. Many thank you for taking the cutbacks. That’s good.
We have not yet received the protective clothing. But a friend of mine in Charlottenburg already has them: three astronaut suits, a box with FFP3 masks, a box with mouth-nose protection, gloves. If there are really only three overalls, that would really be too little.
Friday, April 3, 2020
Confirmed cases across Germany: 79,696
The intensive care: We still have four Covid patients – three of them intubated, one has only been monitored so far. The ventilator pushes the patient into the lungs at high pressure three to four times more oxygen than the normal oxygen content. That is also stressful. Basically, the longer the ventilation lasts, the worse the prognosis.
I was busy with non-Covid patients intubated tonight. Circulatory monitoring, I did a blood wash for one, plus basic care – washing patients, making beds, changing infusion material.
At the moment there is this phenomenon of people standing on their balconies and clapping for the nursing staff. Honestly? I find that ridiculous. And my colleagues feel the same way. We have a note on the pinboard: “Great clapping, I can then pay my next rent from.” This appreciation will not last. When Covid is over, you quickly forget it.
Jens Spahn said that he cannot rule out the fact that there will also be conditions in our hospitals like in Bergamo or New York. That is correct. Nobody can rule that out. We have been waiting for the big wave for 10 days now. I actually thought it would come faster.
The family doctor: Today fewer people were there for cutbacks. A patient who tested positive for Corona called me. He can't get up anymore, he said. I heard from his breathing on the phone that he needed help and I called the emergency doctor who drove him to the hospital. Now I'm going to make a home visit.
I was hoping for new protective clothing, but no news came from the statutory health insurance association.
Last weekend I built a tree house with the children in the garden, for a change. That was really good, even if there are only two posts so far. Unfortunately, this weekend won't work out, I have to do the billing in practice.