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Professionals report delivery delays to patients arriving at Emergency Care Units, where there are no fans for everyone.
A patient with covid-19 arrives at an emergency care unit in Pernambuco. In serious condition, you need a fan, but there is not equipment for everyone. In front of the doctors who cannot help, he dies.
Local doctors report scenes like this, especially in UPA (emergency units), the gateway to emergencies, where patients wait for a place in hospitals. “The field ICUs are even managing to act at the limit of their capacity, but we have a very difficult bottleneck in the ICUs. They were forgotten,” says general practitioner Joabe Oliveira Vasconcelos. “There is not enough of a fanatic for everyone. I already had to choose between two patients.”
The state health system has shown that it cannot handle the number of patients in the coronavirus crisis. Pernambuco had 15,588 confirmed cases of coronavirus and 1,298 deaths as of Thursday (14). The Pernambuco Health Department did not answer specific questions in the report about queues to access ICUs and bed occupancy in the state.
Pernambuco’s health secretary, André Longo, has already said that there is a line for beds in the ICU in the state, which is “extremely dynamic” and can have, at a certain time of day, more than a hundred people. The state government decreed its quarantine in five municipalities in the metropolitan region of Recife, starting this Saturday (16), until May 31.
BBC News Brazil compiled reports from five doctors on the difficult situation they face on a daily basis.
‘I have seen patients approach death sitting in a hard chair for 48 hours due to lack of bed’ – Joabe Oliveira Vasconcelos, 28, general doctor of UCI and UPA in Recife
“I am working 72 hours a week in ICU and UPA. Campaign in ICU until they can act to the limit of their capacity, but we have a very difficult bottleneck in primary care, at the entrance door to the emergency, which are the UPA “. They were forgotten.
There is not enough fan for everyone at UPA. I had to choose between two patients [sobre quem seria intubado e colocado no ventilador] and chose what apparently had the best chance of survival. It happened in more than one turn, and it continues to happen, because the number of fans is not enough.
I am outraged at the lack of resources so that everyone receives the care they need. It is a basic right.
Patients are transferred from UPA to hospitals between 24 hours and more than 72 hours. There are patients who remain intubated for 4 or 5 days in the UPA. Their lives are at risk.
It is very common to have patients in the UPA, approximately 10 patients at least per shift, who receive oxygen in the catheter, but without a bed to stay, sitting in a hard chair for 24 hours, 48 hours.
They complain of discomfort looking at us and us without being able to accommodate them in bed. This is horrible, man. Having a 48 hour person looking at you asking for a bed and you cannot offer it. The elderly and the elderly suffer greatly because the disease worsens, they feel sleepy in front of us and there is no place to put them. It is unworthy. I have seen patients approach death in this way.
One of the biggest fears patients have is that they will be intubated and never wake up again. A 56-year-old patient told me, “I am afraid of being intubated and never going out, doctor.” And I heard that in 24 hours he died. It was very difficult for me because when I intubated it I gave him some hope, I replied that this was the best chance I would have to survive, and it was not.
Last week, I saw a patient who was 33 years old. When I arrived on duty, he had been intubated for about 10 hours. He was an obese patient and his illness worsened absurdly within 24 hours. I spent 30 minutes trying to revive him, but unfortunately he didn’t survive. And to give the news to the family and brother that the person who was with them for less than 24 hours would never be, without having the right to see the body and have a moment of mourning? That was the most tragic for me. “
“It is not easy to see a patient die in front of you due to the lack of a ventilator” – Anonymous general practitioner, 30, works at ICU and UPA in Olinda
“The UPA is getting to the point where it is impossible to cope with demand. The rooms are filling up with critical patients. We don’t have enough staff or mechanical fans for everyone. This ends up causing a cycle of chaos.”
Intubed patients wait for a bed in the ICU, but there is a long line. It takes time to get this patient’s password [para ir para a UTI], it takes a long time to transfer and the patients become more serious. Sometimes ICU password is issued and there is no transport. Rotation of the oxygen source is already frequent, as they are very patient and limited sources.
We have already reached the point where we have all the beds occupied, we reach a serious patient who needs to be intubated, we cannot and the patient dies. And it will happen more often.
The team is suffering from mental and emotional exhaustion because it is not easy to see a patient die in front of you, you have the technical capacity to help him, but a mechanical ventilator is missing and he dies. The sadness, despair and crying of the team. Elderly … young man with no history of comorbidities.
[Um paciente] He arrived with his daughter, who found the disorientation at home strange. Had 55% oxygen saturation [o normal é entre 95% e 100%]. There was no respirator available … We managed with what we had and made comfort measurements in parallel. He died after 3 hours, purple from shortness of breath, in front of the team. Chaos for mental health. No one deserves to live it! Neither the sick person nor the professional who works to give priority to people’s health.Me and the colleague on duty were left without a floor, answering between tears. We had six more patients in the room and two more who would soon have respiratory failure. We follow it, but we feel the consequences in the body. The colleague has anxious crises. The next day I fell asleep, passed out. Did I dream about it? And what is worse, there is a persistent thought of what should have been done, if we forget something … Too tired.
I still haven’t panicked for some reason that only therapy and meditation baggage should explain later. The situation is really getting difficult. The siege is closing. The prospect is that it will be a great catastrophe. “
‘I’ve never seen so many people die at the same time’ – Everton Abreu Lopes, 32 years old, clinical doctor, works at ICU in Recife
“All day is covid-19, from start to finish, in the three hospitals where I work. On average, per day, I am responsible for 30 ICU patients.”
And I guarantee you that the health system in Pernambuco has already collapsed. [a conversa com a reportagem da BBC News Brasil foi em 29 de abril]. The published figures, which are between 97% and 98% occupancy rate, are completely misleading. I say it is 130%. What is happening is that many people are trapped in the UPAs, because they don’t have enough transportation, they don’t have ICUs.
And that is one of the main reasons for the high mortality rate in the state. The moment in which the patient arrives at the ICU is decisive. Serious cases do not reach my hand until much later than necessary, four or five days. I do not see the patient at the beginning of the image, when it is possible to make a more successful intervention. When it arrives, it is too late, very difficult to reverse the situation.
I have been working at the ICU since I graduated, so I am used to seeing people die and giving news of death, it is my routine. But I have never seen so many people die at the same time. And the worst thing of all, for me, is giving information over the phone, since the relatives cannot be close. Personally, it is easier to create empathy. We look each other in the eye, perceive emotions and even create techniques to speak, speak slowly. When you provide information over the phone, people are not prepared. We don’t know where the person is, if someone is nearby.
One day, I told a woman about her husband’s death and she was in the middle of the street. It is very distressing not to know if she was okay, I just heard her gasp and the noise of the city. There was no one to hug her. That borders on coldness.
I never had trouble sleeping, insomnia. But now, many times I wake up at dawn, at 1 a.m., at 3 a.m., unable to close my eyes anymore.
‘I am on duty wondering how many families I will give the terrible news that they will never see the relative again’ – Anésia Bezerra da Fonsêca, 31 years old, general practitioner of ICU and UPA in Recife
“I am working 84 hours a week. We leave the house every day thinking it will be even worse than it has already been. Colleagues and nursing technicians are nervous, exhausted, tired, due to the workload. We see the scared look of the patients, who do not know what will happen … They look to the side and see that someone is getting worse, someone who was speaking recently and who after a few minutes had to intubate themselves, sometimes they witness deaths.
Families bring the patient to the unit and do not know when they will see him again. After entering the covid unit, you do not know when you will see the patient, many times you will never see him again.
This week I reported some deaths. We arrived on duty asking: “How many families will I have to give the terrible news that the person who does not see in a few days will never see again?”
In some cases, you have to break the news on the phone, and it’s terrible. As much as we try to be the most welcoming, to say the best words, there is that emptiness of physical presence, the gaze. It is the “cold phone”. There was a death notice that the only thing the family could say was ‘thank you’. How can it be? I am giving you the news that that person’s brother has passed away and he is saying thank you because ‘at least my brother had a chance here in this ICU.’
At the UPA, we ask for a place for a patient who is stable and able to go to the infirmary, but often the delay in obtaining the place ends up getting worse and needing a bed in the ICU. So it is another wait for the ICU bed. We are anxious, hoping that everything will turn out well and leave this vacancy soon. It often doesn’t happen, and I’ve seen patients die waiting for a place in the ICU.
There was a patient for whom we did everything we had to do at the UPA and at the end he said: ‘I can’t take it anymore. Please, doctor, intubate me. Where do you see such a thing? Patient who asks to be sedated, intubated and lose control over himself.
My life, like everyone else’s, has stopped. I am living to work and working to live. I was willing to work with them so they could open more beds, but I’m going to decrease because this is really affecting me. Sometimes we have to report deaths more frequently and there is no time to recover. “
‘I see people on the street, they don’t take it seriously, and every day there are more and more sick people’ – The 32-year-old anonymous general practitioner works at UPA in Recife.
“The volume of patients in the UPA is much higher than we can get. When this whole story of pandemic began, the State opened nursing beds and ICUs because it must be beautiful for the press, but it did not structure the UPAs, the link, which is where the patient runs, to meet demand UPA is a service that has to be temporary, the patient has to arrive, be evaluated and transferred to another service.
But it takes more than a day to transfer the patients admitted to the UPA. There is not enough respirator and oxygen source for everyone. We have a patient who needs a respirator, but we have the oxygen source because there is no respirator available.
Sometimes we have patients who need the oxygen source, but they run out because they don’t have enough. The medical team is very short, there are many sick people. Shifts that should have four on duty, we have in two.
Do you know a funnel? It is so. The number of patients who arrive has a very large volume and the production is small.
Each turn is a great anguish. Aside from the fear of getting sick, becoming infected.
It is a disease that causes great suffering in the patient. They arrive tired, they need oxygen. Those who die go from respiratory failure. It is a very sad thing to see. It is extremely distressing, we provide support, but we feel very helpless.
I do not follow more news because I am anxious. I see people on the street … They are not taking it seriously, and there are more and more sick people. “
