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RIVER. Endless days of work that have already brought them to a level never before experienced physical exhaustion and, above all, emotional exhaustion. With the public health system collapsed and the private one saturated, already registering delays in the hospitalization process, doctors Intensivists at the forefront of the fight against the coronavirus pandemic fear that low adherence to social isolation in states like Rio de Janeiro could cause a real health catastrophe. The images of people walking on the streets, in many cases crowded, are today one of their main reasons for anguish, they said in a statement to GLOBO. Within hospitals Where they work, they claim they have never treated so many patients in such a serious condition at the same time. Faced with a disease for which there is still no treatment today, they claim to be “changing tires with cars in motion.” Some cases cause deep blows, especially when they must intubate a familiar doctor or even a friend. In a Brazil that today is already the seventh most affected country in the world by the coronavirus, with 179 thousand infections and 12,4848 deaths, the intensivists feel that the peak reached may end up becoming a plateau due to the weakening of social distance measures. In Rio, there are already 18,494 infected and 1,984 deaths. For these doctors, each death is a defeat that is difficult to digest and that, at times, makes them cry copiously for the impotence of not being able to save more lives.
Dr. Rodolfo Espinoza – National Cancer Institute (Inca) and Star Cup
Mother’s Day Sunday was the first day I hadn’t set foot in a hospital in three months. In Inca, due to lack of human resources, I began to help on duty. We are organizing our work on a daily basis, making decisions as situations arise. Vacancies are sometimes scarce in Rio’s private hospitals, especially in the Southern Zone. Last weekend, we just didn’t collapse because we opened new beds. On many occasions, we have 100% occupancy in the private network and, on average, we are at 90%. I have been an intensivist for 20 years, I have never experienced anything like this. In the private network, I am the CTI coordinator and we are constantly expanding the beds, dealing with the lack of doctors, hiring professionals, encouraging the team because we cannot drop the wheel. We are all working hard, we are focused. Who gets infected, returns from the quarantine very committed, wanting to help, this is very beautiful. But it is also true that there is a lot of fear. Last week, I had to intubate a 29 year old resident of mine, that moment was very difficult for me, one of the most difficult so far. We have hospitalized colleagues, many with respirators and in serious conditions. We still don’t know much about this disease, I personally have never seen such serious diseases in such large quantities. This is a challenge for everyone. We are at the top, many people die in public and private hospitals. Mortality is higher than what is presented and I find it impressive that some people still deny this reality. I am outraged by this and very concerned. What depresses us the most is mental fatigue. We never hang up, or we are in the hospital or at home. And many doctors have trouble sleeping. Many are eager to know if they will get sick or not. There is no treatment for Covid-19, we only support patients. What is saving lives is having a multidisciplinary ICU, because they are difficult patients to manage, everything is very complicated. We are increasing our team, we even hired 30 doctors in 48 hours. For us who face this pandemic every day, seeing the lack of conformity and abandonment is terrible, we feel it as an affront to our work. At Inca, Covid cares for all beds and our fear is that it will affect cancer treatments. The big dilemma at Inca is whether we treat time-dependent diseases, those that need surgery or chemotherapy, or whether we avoid exposing our patients to Covid. I am married and have three children, the two oldest living with my first wife and I see little. The little boy, two years old, sees me leaving the house early and returning late. And we know that this will be our life for a long time.
who: “There is a long way to go until the end of the coronavirus pandemic”
Dra Roberta Lima – Intensivist in Copa Dor, anesthetist and cardiologist at the hospital of the Federal Fluminense University (UFF)
I was a widow two years ago and I have an eight-year-old daughter named Clara and every night she expects me to play hopscotch at home. I work long hours, some days I come home at midnight and my daughter is there, waiting for me. I am asthmatic, I have not been infected and I hope to continue like this. We are all concerned about the saturation of hospitals, we still have room to grow, open new beds in the ICU, but our degree of elasticity has a limit. We have already redistributed various sectors of the hospital and today several floors are ICU in Covid. We see a limit in that, very clear. This is why social isolation is so important. Today we fear a higher spike due to loosening, this is our biggest concern. Some people prefer not to see what is happening, they want to keep their life as it has always been. But our ability to meet demand depends on insulation. We also have difficulties due to the stress we are experiencing. We treat very serious patients, who develop many dysfunctions at the same time, this requires a lot of preliminary work. We have a decompression area, where we can remove the masks, deprive ourselves of our rights, because it is very heavy, at all times. It is many hours, the mask hurts our faces, everything is causing great anguish. In the public system it is even worse and we have already heard of cases of nurses who had the so-called exhaustion, took everything off in the middle of a shift and left. People are unbalanced. Some cases are very difficult to handle. I had a man who died and his son did not want to enter to recognize the body, he was afraid of becoming infected. He didn’t even want to give me his cell phone to take a picture. I ended up taking a photo with my cell phone, here I still have it in my files. It was a relief for the son of my patient who took the photo, he was very scared. Hours are many hours, we lose weight, despite trying to eat well. We try to keep balance, in my case, I do meditation, I write, I look for ways to channel stress. I try to help and clarify, because I see many people with no connection to reality. Even close people.
Dr. Luiz Simvoulidis – CTI Coordinator at the Barra hospital of the Unimed-Rio network
On Mother’s Day Sunday, I found myself crying profusely when I lost a 70-year-old patient, mother of three children. We have a great emotional overload, and some situations depress us. Isolating the patients is a great difficulty, that day I had to inform this family that the patient had not managed to survive. I met her at the hospital, she was still lucid. She quickly worsened significantly, was brought to the ICU with shortness of breath, and was intubated in less than 24 hours. He ended up dying on Mother’s Day. The day before, when I saw that the case was getting very serious, I offered the children to send a videotaped message to their cell phone. It was a very great anguish, a feeling of helplessness, of facing an unknown enemy. We don’t have much to do, this is a new disease that we know very little about. We are changing tires with cars in motion. All we can offer the patient are supportive treatments. This woman was a healthy person, her death was a severe blow. We are used to dealing with life and death, but with a withering and viral illness, it’s hard to accept that a 70-year-old, who still had good years of life ahead of him, left that way. Today we have 54 patients, almost double what we used to have in our ICU and we are talking about a single disease. We have not reached the limit yet, sometimes we have to wait a bit, but we have a place. Demand is increasing, and as we anticipate and schedule, we take care of all arriving patients. Our biggest limit is human resources, because we need specialized assistance and you cannot train intensivists in all specialties. We are facing the pandemic with a very united and focused team, and we can deal with the disease. But every day problems arise, doctors and nurses get sick, our workload increases, and there is exhaustion. A favorable environment for cases of physical and mental exhaustion. We would need to take time off for people to do mental hygiene, but often we cannot because we are left without professionals. What gives us more encouragement is seeing the patients in recovery, it shows us that the efforts we are making are worthwhile. We work up to 60 hours a week and, in my case, for example, I had to add patient assistance to the CTI coordination work, because we all have to strengthen the teams. Today, what saves us is isolation, if it becomes too loose we will reach our limit. Without isolation, we would already be at a breaking point. My wife is also an intensive care doctor, we have two children, ages 8 and 14, who already had some symptoms. I already got infected, but it was very light. Those who have not yet been infected are very afraid, each professional sees critical patients as a risk and fears that they will remain the same. We already know that this disease affects everyone, we have lost friends, doctors and nurses.
Study:Covid-19 deaths in Brazil expected to reach nearly 90,000 in August
Dr. David Sulfiate – Intensivist at the Centro Hospitalar da Fiocruz, the Clementino Fraga Hospital of the Federal University of Rio de Janeiro and Copa Star
Photo: Disclosure / Agency O Globo
Since the pandemic started, my work hours have expanded significantly. I am working 130 hours a week, well above the 90 hours I used to work. I would like people to understand that this disease is serious and is teaching us to be patient and resistant, it is changing the social context in which we live. I would like you to help us all think more about each other, because Covid-19 affects everyone, anyone can get sick. Last weekend, there was a waiting list at private hospitals in the Southern Zone. He would not speak about the collapse of the private system, but about saturation. In many public hospitals, vacancies are no longer available, especially in the hospitals we call open doors, these are the most critical condition. We see serious cases in all hospitals, this disease reduces social distances, we have patients in a very delicate state in public and private hospitals, and we lose patients in all hospitals. Our work is tireless and what we wear out the most is contact with patients, because not only are we doctors, we also end up being psychologists, we help contain emotional distress. We deal with unfavorable results every day, it is a situation that demands too much of us. It requires emotional stability on the days when, in my case, I lost seven patients in 24 hours. And the patients are afraid, they are alone, everything is very difficult. We see colleagues dying, university professors, friends who get sick all the time. I lost a teacher who was only 41 years old, admitted to a private hospital. We are at a peak, but in Brazil this peak will be a plateau due to our social dynamics. The crowds continue and the sick will keep coming. For the expected curve, there are not enough beds and that is why social isolation is so necessary.
