IThey work in hospitals or in town medicine, they are generalists, nurses, emergency doctors or midwives: around fifteen caregivers, on the front line against the Covid-19 pandemic, have agreed to tell us about their professional daily lives. Every day, in this “crisis diary”, The world publishes a selection of testimonies from these “white coats”.
“Sorting the patients is what we do all year”
Mathias Wargon, 53, chief of emergencies at Delafontaine hospital, in Saint-Denis (Seine-Saint-Denis)
“On the TV sets, politicians, but also colleagues, are protesting against the sorting of patients. In fact, they discover with the coronavirus what we do all year and what is the job of a geriatrician, a resuscitator or an emergency room. In the emergency room, it is very often decided not to send a particular patient to intensive care. It’s not a decision that you make alone on a corner of the table. It is a collegial decision that one makes with the family according to a main criterion: the autonomy of the person.
“As there is starting to be a shortage of morphine and midazolam (a sedative), we are using Ritrovil (an antiepileptic) to relieve the pain and anxiety of choking patients”
If the person is bedridden or with very advanced dementia, we are not going to place him in intensive care because we know that he will not get out of it better. Resuscitation is an extremely violent shock, a long process with an uncertain outcome. That’s why people in Ehpad (accommodation establishments for dependent elderly), without autonomy, we do not revive them.
With the coronavirus has been added disaster medicine where you cannot squander increasingly scarce resources. We are not trying to resuscitate a patient who requires too many means. This is the doctrine applied during the attacks in 2015: people who were too seriously injured, we did not try to save them to concentrate the resources on those who we thought could be. It’s a pragmatic reaction and an ethical choice.
And all these people who are not going to resuscitation, our goal is not to kill them faster – as I sometimes hear with the hysteria around the use of Ritrovil (an antiepileptic) – but don't let them die suffering. It’s the least we can do. We are not going to suffocate them with a cushion! As there is starting to be a shortage of morphine and midazolam (a sedative), Ritrovil is used to relieve the pain and anxiety of choking patients. “
“We hope to have great patient stories soon”
Pierre Hammoum, 25, intern in intensive care at Lariboisière hospital (Paris 10e)
“I never thought I would experience health transfers of this magnitude in my professional life. We transfer our stable patients to other regions to receive those who are worse off. We are in real disaster medicine.
“We have to find other ways of giving news: either by messaging or by phone. These calls are not easy and take time ”
A priori, the peak would be expected between today and next Saturday. If the containment is successful and other areas remain less affected, this would be a huge opportunity. We would be able to hold on.
It's very weird not to see the families of the patients. Usually, in the intensive care unit, visits are possible around the clock and family reunions are organized. There, everything is suspended. We have to find other ways to give news: either by messaging or by phone. These calls are not easy and time consuming. This is done when there is a deterioration or an improvement in the patient.
We have several patients with whom we are doing well, who have slightly better lungs. We hope to have great stories soon. “
“Whatever the danger, we end up adapting to its existence”
Julie Oudet, 39, emergency doctor at SAMU Toulouse (Haute-Garonne)
“We feel that it is seriously increasing, with more and more people with severe symptoms calling for SAMU (emergency medical aid service), more and more patients in the intensive care unit. Fortunately, we are not at saturation point.
We try to adjust constantly: we are lucky to have this delayed increase in power, compared to others. So we're working on the procedures: which stretcher-bearer takes care of Covid patients, non-Covid patients, how we take them down to the scanner… All these little things that need to be improved before being overwhelmed, to be as efficient as possible. Always with this fear of being “HS” at any time: I tell myself that maybe tomorrow I will have 40 ° C of fever and, without even a severe form of the virus, I will no longer be very fresh for to work.
“There is still a lot of concern, of course, but we are starting to be in a known area, which reduces fear”
Right now there is no day off. I advance on the protocols, and I replace one hour a colleague who performs call regulation, so that she can take a real lunch break. These are small efforts that we all make, that change things to last.
If, at the beginning of the crisis, the people who called the SAMU could be extremely anxious, I have the impression that it is a little “less worse” now. There is still a lot of concern, of course – patients know there are serious and less serious forms – but you're starting to be in a known area, which decreases the fear. In the collective unconscious, this stranger was like the plague coming and they were all going to die. We are no longer in this fantasy and this unfathomable fear. Perhaps also, whatever the danger, we end up adapting to its existence. “
“Covid-19, I did not learn it on the benches of the university”
Laurent Carlini, 33, general practitioner and emergency doctor in Ajaccio (Corsica)
“At my office on the outskirts of Ajaccio, my patients have never been more attentive and involved. They are anxious. Many ask us for our opinion on hydroxychloroquine or ask to be tested.
The majority of our at-risk patients obtain a negative screening result. But since we know that there are about 20% false negatives, we explain to them that it does not mean anything, and we recommend to those who have very suspicious symptoms to take the same precautions as if they were positive.
“When they arrive in consultation, our patients already know everything. They are on an equal footing with us. This is the first time that it happens to me “
Since confinement, people have seen many doctors and politicians talk about the virus all day long on television. They have the information with us. So when they come to the consultation, our patients already know everything: the symptomatology of the pathology, the precautionary measures, hydroxychloroquine … They end up on an equal footing with us. This is the first time that it happens to me. The Covid-19, I did not learn it on the benches of the university …
We are happy that our patients are vigilant. More than half of them take their temperature every day, even those who have no symptoms. They know that fever is one of the first of them, so they do it with their weapons.
We also receive a lot of worried patients because they are exposed to contact with the public, but they do not have sufficient means of protection at their workplace. This is particularly the case for cashiers, on the front line. They are arrested for a few days, enough time to reassure them. There is no excessive overtime, but it allows them to step back and cut a little with work. “
“Residents know the disease is coming, but they don't talk about it”
Mathilde Padilla, 21, nursing student in a care and rehabilitation center for the elderly in Rouen (Seine-Maritime)
“So far, we have been in a bubble in Normandy, while the other regions have been at the front in the face of illness. It's over. Friday April 3 at noon, during the transmission phase between the morning and evening teams, the health manager informed us that the region was not a sanctuary: six people died in the Ephad in the territory. The Covid is coming.
“I have planned to come with my ukulele. This is the only instrument that I can disinfect perfectly without damaging it too much “
Residents also know that the disease is approaching. They don’t talk about it, they’re always talking about other things, the rain, the weather today. They are interested in our lives as caregivers, what we do when we pass the door of the health center. Confined, without visiting their families for four weeks, many suffer from loneliness. They hope to reflect us from the outside, they need it. We all need it.
To give them a little cheer and break the monotony of this spring, I imagined playing music to the residents. I planned to come with my ukulele. It is the only instrument that I can disinfect perfectly without damaging it too much. I proposed this project to my referent caregiver then to my referent nurse, then to the health manager and the whole team, all were enthusiastic.
On the program: standards of French song that I will repeat this weekend, Dalida, Charles Aznavour, stuff from their generation. “