Witness of recent breaths: what happens to a patient in resuscitation due to coronavirus

I’m talking to Edoard and I’m concerned about some things. First: how is it there? On the front lines of combat warfare, everything is happening. What matters to me is not the gaze of the professor of epidemiology, the doctor who has reached the peak of his career, but that of an ordinary nurse.

The second thing: how do you feel, what emotions does a young man face when he faces death every day? He swallows the electrodes from his still warm body, which is no longer alive, wraps them in a sheet, puts them in a special body bag, returns home, has dinner. Are you asleep?

And one more thing does not give me peace of mind: why do you want to work this job instead of going kick the ball with your teammates more often? Who needs all this?

The conversation with the fight resuscitation nurse was calm and serious. At times it even seemed to me that I was walking with Edoard after the intensive care unit. And sometimes it seemed like he was talking to a veteran of Vietnam or some other war. No drama, no romantic stance, or pride in his activities as a testament to his dying breath.

– Where do you work and what are your responsibilities?

– I am a nurse in the intensive care unit of the Istituto Clinico Casalpalocco, a clinic specialized in Covid-19 disease.

– Are only patients infected with Covid-19 treated at this clinic? How many beds are there? How many beds in resuscitation?

– When the coronavirus pandemic broke out, only so-called combat patients were treated here. We have 120 beds, four compartments. There are 24 beds in my intensive care unit, but they are not enough, another 10 beds will be installed soon.

– And what diseases were treated in this hospital before the pandemic?

– It was a high-level specialized cardiac surgery clinic. Various heart surgeries have been performed here, including heart transplants.

– At what age are patients hospitalized in your ward now and during the first wave of the pandemic?

– In the spring, we had most of the older people, eighty years or older. Now we are increasingly faced with much younger people, in their sixties and even younger. There are also quite young people.

– At what age was the youngest patient in the intensive care unit?

– My partner is a 23-year-old boy. He was healed.

– Do all your patients receive oxygen? Do they have a fever?

– No, patients with primary symptoms such as fever are treated in treatment rooms. We only have those who have obvious symptoms of respiratory failure.

– In other words: your intensive care unit – a unit for suffocating, suffocating patients?

– If right.

– Tell me, please, what happens to the patient when he is in combat resuscitation.

– First I have to move the patient from the stroller to the bed. Then I connect the sensors and electrodes for various vital signs. I measure blood pressure, heart rate, blood oxygen concentration. Based on this indicator, we begin to ventilate the lungs. I insert a catheter into the bladder for all patients without exception.

– Is an oxygen helmet worn on the patient’s head or is it intubated immediately?

– It all depends on the degree of alteration of respiratory function. Intubation is a last resort to help the patient. Initially, we try to compensate for lung failure with an oxygen mask or an oxygen helmet.

– Is an oxygen helmet an invasive therapy? Does it cause discomfort to the patient?

– No, it is not an invasive ventilation method. However, for some patients, an oxygen helmet causes psychological problems.

– Which?

– Sometimes a panic attack occurs.

– What do you do in that case?

– I try to explain the situation to the patient. We changed the helmet to intense ventilation through an oxygen mask. Or we intubate.

– Are resuscitation patients with respiratory problems calm? On the contrary, distracted, worried?

– It may seem paradoxical, but those patients with severe oxygen deficiency syndrome are completely calm. They find it difficult or very difficult to breathe, so every strange movement makes them extremely tired.

– Are they sitting or lying down in resuscitation?

– The most common position – semi-lying.

– If the oxygen helmet doesn’t help, then do you have to intubate? Does the intubated patient remain conscious?

– No, the patient falls asleep before the intubation procedure.

– Is intubation performed by a doctor? How long does this procedure take? It is painful?

– Intubated by a resuscitator, lasts from 15 to 20 seconds. If this procedure were done in a state of consciousness, I think it would be painful. There are two possible methods of intubation: the tube is inserted through the throat into the windpipe. Or minor surgery: a tracheostomy.

– You said intubation is invasive. What does this mean? Are there additional risks?

– Yes, the vocal cords, for example, can be damaged during intubation. But these are extremely rare cases.

– How long can intubation last? A few days?

– It may take a few weeks. We have a patient intubated two months ago.

– He will get over?

– Most likely. But small.

– Were there enough young intubated patients?

– Yes, the age of patients intubated during the second wave of the pandemic does not increase, but rather decreases. It happens that those who have reached the age of 45-50 must be intubated.

– Can the patient refuse intubation?

– If you can. If you are aware, you can sign a statement of resignation. If he is unconscious, we intubate because it is the only way to prevent the patient from dying.

– Approximately how many intubated patients do not recover, die?

– It’s difficult to deduce the average … Now, I think 3-4 out of 10 patients die.

– You read that you nurses give dying patients the opportunity to say goodbye to their loved ones, dial a phone number. Is it really the case?

– Everything happens … Sometimes the patient wants to call, talk to relatives before intubation. This is understandable because no one knows the subsequent result.

– Do people die in a state of consciousness in combat resuscitation?

– Happens. But rarely.

– Do you often see dying patients?

– Yes.

– What do you have to do after the death of the patient?

– First, certain protocol operations are performed to indicate whether vital functions have been interrupted. Suppose a cardiogram is performed, if it remains flat at 20 minute intervals, it is already a confirmation of the fact. Then I have to unscrew the electrodes, disconnect the monitor, remove the mask, remove the various tubes. Tight on the chest arm, we place the deceased in a special body bag.

– Do these images affect the psyche?

– Yes. But in college, I had to take a special course on how to deal with these cases. Training programs prepare you to face death.

– Did you graduate from college?

– Yes, I have a college degree in nursing. The vast majority of nurses working in intensive care have completed higher education.

– Are you afraid of getting infected, of getting sick while watching your patients suffer?

– I was already infected …

– Where? At the hospital?

– No. At a friend’s birthday party … Our hospital has an extremely high health security protocol, so the chances of infection are low. I’d say it would be a lot easier to get infected in a mall.

– What is your work schedule? How long does a shift take?

– 12 hours: from eight in the morning to eight at night. Or from eight in the afternoon until eight in the morning. But often the section has to take time. Suppose you brought in a patient without five to eight that day, had to take him in, prepare him. In such cases, of course, I do not count the extra minutes. After six hours of work, there is a break: go to the bathroom, have a snack, have coffee. Of course, if I count all the time from leaving home, changing clothes, getting ready for work, going home, my workday lasts 14-15 hours.

– And how many such shifts a week? Per month?

– The official limit is 180 hours per month. But now there is a huge shortage of highly skilled nurses, so we have to work 200 to 250 hours a month.

– How many patients do you have to take care of at the same time?

– Our care is constant, the patient is monitored 24 hours a day. According to the regulations, there are two combat patients per nurse. As I mentioned, now there is a shortage of staff, so I have to work with three or four patients.

– What jobs and actions in the department bother you the most? What would you like to avoid if you could?

– I can say frankly: hygienic care. The work of cleaning the patient is usually done through specialized sanitation, but it is also lacking, so I have to clean, wash … In any case, I must be around, check electrodes, tubes, wires.

– How much does a resuscitation nurse earn?

– In different ways. In northern Italy, more, here in Rome, less. My salary is € 19 an hour before taxes. If you worked in Bologna or Milan, you would earn double.

What do you think of the so-called non-nationalists, those who deny the danger of the virus and the means of protection? Do you feel hated by them?

– No. I’m totally indifferent … It’s true, I recently put two deniers on resuscitation. Those men admitted me between one ventilation procedure and another they vehemently denied … They apologized. He promised to leave the hospital to fight denial.

– Admit it – Do you dream of death at night, the dead?

– No. When I come home, I try to fall asleep, rest, distract myself. I go out to the city, I meet friends. I try to live a normal life for normal people.

– What is the most important characteristic of your character and behavior in your work as a circus resuscitation nurse?

– Ability to keep cool. Calmly analyze the situation, calmly respond to stress, do not let go of emotions.

– Why are you doing this job? After all, are there many easier activities for a 23-year-old?

– I like my job. On the other hand, it contains a lot of adrenaline, tension, responsibility. But I also like it.

– The last question: you help people to overcome death, but you also have to see the dying man’s last breath. Do you feel like a hero?

– No … At best, I feel like an ordinary combat warrior.