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The navy jumpsuit from the Mobile Emergency Care Service (Samu) is hanging on a hanger outside the base. It is one of the changes imposed by the increased need for care in times of coronavirus. These changes extend to the plastic that now surrounds the interior of the ambulance and makes it easier to clean up after handling suspicious cases, and the use of face shields, masks, and waterproof aprons that lend dramatic costumes to the already dramatic scene of the pandemic.
The sealed and numbered death certificates have yet to be completed, each with its three copies (one white, one pink, and one yellow), and the shrouds (two for each body) give the measure of what the changes have been. of rescuers in the city of São Paulo. The team’s ears are trained to understand a language that for a layman is just a whistle full of codes that come from two radios. Due to wheezing, it is important to know the number of the ambulance (if it is yours, start preparing to leave) and what to expect regarding the conditions of those requesting emergency assistance.
The guidelines are given by a central. In the last month, special attention has been paid to code 36, which indicates respiratory failure. If accompanied by the delta letter, the condition is serious and needs immediate assistance. The combination of number and letter has led to an immediate association: suspicion of covid-19. There were 5,998 calls under these conditions in the last 60 days, according to the City Council, which is equivalent to one hundred calls a day.
The State This week he accompanied a duty at a city base. There, the report spoke to a doctor with more than a decade of experience in prehospital care. The night and sunrise ended up being surprisingly calm, especially compared to the previous April shifts. Those were days that, according to the professional, the almost exclusive task was to verify the deaths in the residences of the city, most of them with some suspicion of coronavirus. In 24 hours, there were not five minutes left to rest.
This week, the City said it will hire specific teams to perform this service, returning to leave ambulances to act in urgent care, as requested by employees. “There was no point in resorting to the care of the living,” said an official.
During the past month, this doctor, who will retain his identity at his request, noticed an intensification of the coronavirus in the peripheries and entered the houses of the victims, where he frequently left after leaving a death certificate with his relatives. Part of what he saw on these visits and his perception of the disease in the city can be read in the following statement, which was given while waiting for the next call:
“I remember the last death check that I did well. It was in Cidade Ademar (in the south of São Paulo), a poor, poor, poor place. We actually reached the edge of the house, in the cabin. The victim had been coming for four days with a cough and a fever. In the morning, he didn’t want to eat, and when they went to see him in the early afternoon, he was dead. A man in his 40s with a mental disability. “But didn’t you take him to the hospital? “” We don’t take it because everyone who goes to the hospital says they can’t take the test, which is to go home. It wasn’t that bad, but he died suddenly, “they told me there.
People have had this experience at some point in their lives of having a little cough, fever and body pain. It seems to be just another flu. Only it is not. It is a flu with a totally different and very treacherous behavior. For certain people, it will kill.
I went in to see. It was a shack with a room like those that extend inward. A room with five beds. A window to the back, which was a service area. The aunt, who cared for the man, was lying on the sofa with difficult breathing. “You saw a person die, take that woman now to the hospital,” I told them. ‘I’m fine, doctor. I won’t, no. ‘ It wasn’t right, I could tell by his breathing. They arranged a car to take her to a nearby health center, but she did not want to go. The victim’s brother was also in the house and continued to cough, cough and cough. And people who enter and leave that polluted environment as if it were normal.
How normal is all this? How is it normal to die? But I think it has to do with how much suffering these people carry in life. This may be another stage of life that is difficult for them. It is difficult to get up early, risk at the bus stop at dawn, live with the routine of violence in the peripheries. Death is part of the daily life of those who live on the periphery. The death of people who should not have died, either due to violence or because they did not have access to a good health service. Society lives with different values in Cidade Ademar compared to Higienópolis, fundamental values such as the right to life. When I went to declare deaths in the most peripheral areas, I realized how cruel the reality of the epidemic is.
Still, the family welcomes him, but he must access the victim in the environment where the death was to see if there is anything there that suggests a violent death. You have to undress the person, take off their clothes to see if that death was not due to an external cause. The process of stripping the person and examining the intimacy of that body is not an easy one. The family has never witnessed and is being invited to attend because we need someone in the family to testify that we are not doing something unethical. It is a very meticulous and thorough examination.
Then there is the collection of the covid exam, which looks silly, with a cotton swab in the nose and another cotton swab in the mouth, but it is an invasion in that body that died. Picking up the back of the mouth is not always easy. The death may have occurred eight, ten hours ago and there is already rigidity. You have to force it to put the swab in your mouth.
So, let’s prepare the body. All those clothes that were cut, we did not take off our clothes, we cut them, and that was left open around the victim, we are going to use the sheet that was about to fold and a second sheet to wrap. It is placed inside the first cover, it has a zipper that closes, which ends closing on the head. We always leave our faces a little outside to offer the family a moment of prayer. Watch for five minutes. We have to put a second cover after cleaning the first one and then close it permanently. The family will no longer have access to this person, they will no longer be able to touch them.
When we arrive on the scene for cases like this, the family sometimes waits for hours, which is also very exhausting. You have a loss of a family member and wait hours. It depends on the State, there is nothing to do, there is no way to change this course. You have to settle and wait.
The State arrives, Samu is a representative of the State health that arrives there to try to provide a solution for what previously had no solution, due to the previous need, he was not competent to prevent this death. Somehow, after death, the state has to go there and people are still grateful. The State could not avoid that death, which is an avoidable death. Covid death is a preventable death in most cases. Pipe, take good care of yourself. It will not save everyone, but it manages to greatly reduce mortality.
With each shift, we feel that the epidemic problem is getting worse. I do not think that the situation here is less bad than in Italy, Spain, France or the United States. We do not have the conditions that Germany has, either in the ICU bed or in the ability to test for coronavirus. Our conditions are nothing like what we have seen in Europe. Our sanitary conditions are worse, the population density in the peripheries is very high. So what we are imagining is that our situation will be as dramatic as it was in those places. “
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