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In the intensive care unit of La Timone Hospital in Marseille, Dr. Julien Carvelli is on the phone. Family members should be up-to-date on how their children, husbands or wives who are severely affected by covid-19 are doing.
Carvelli makes at least eight of these difficult phone calls every day. You only have time to spend a few minutes on each one. The intensive care unit is full.
TALKING TO FAMILY MEMBERS: Dr. Julien Carvelli calls patients’ families to keep them updated on their health status. Photo: AP
In Marseille, more people have ended up in hospital now during the second wave of infections than during the first this spring. Many are very sick. Carvelli tells a father that his son will probably have to go into a coma.
– Right now he is doing it alone, but we are very concerned about his breathing, says Carvelli.
It’s a long break at the other end.
– Do the best you can, finally answers the father.
Exhausted and frustrated
France has been closed for two weeks, after the infection spiked again this fall.
Just over 45,000 have died in France so far from the pandemic. Currently, 33,500 patients with covid-19 are hospitalized, almost 5,000 of them in intensive care units.
At Hospital La Timone, which is the largest hospital in the south of France, there has been an influx of corona patients. The doctors and nurses are working hard.
HARD DRIVING: We just have to persevere, says hospital staff. They take over the twelve-hour shifts in the infection control team. Photo: AP
The latest figures give hope that the worst may soon pass and that the peak of infection has been reached. The number of admissions nationwide dropped somewhat over the weekend, for the first time since September.
But frustration among healthcare professionals has not diminished. Many believe that authorities did not pass the months after the first wave of infection well enough to prepare the country for a new wave. And while the doctors and nurses this spring were hailed as heroes, now no one is clapping.
– There was applause every night. Now they say we’re just doing our job, says nurse Chloe Gascon, 23.
Slow reset
In Marseille, the second wave of infections has affected the population much more strongly than the first. The virus spread rapidly in the Mediterranean port city after the summer. The bars and restaurants closed on September 27, a month before the national shutdown. But it was still too late.
A series of budget cuts over the past decade have cut the number of intensive care units in France in half. Authorities promised to spend the summer increasing capacity.
– Summer was a good time to act. At the time, the infection was at a low level, but at the same time it was boiling all the time below the surface, says Stephen Griffin, a virologist at the University of Leeds.
But it was not until the fall that work began on a new emergency service at La Timone Hospital. It was ready for use two weeks ago, but the cables are still visible and the fiberboard is taped up. They have also had to wait for the promised reinforcements in the squad.
NOT SATISFIED: After the previous closure, the French authorities promised more resources to the hospitals, but in the corridor they are not happy with how little has come. Photo: AP
Intense and risky
Compared to the emergency room, the intensive care unit is a quiet place, with some hectic interruptions as the patient needs more oxygen or other immediate help. And then there is the constant sound of machines beeping.
When the twelve-hour shift begins at seven in the morning, the 16 beds of the intensive care unit are full of patients with Covid-19. Only five of them are conscious.
In those in an artificial coma, two nurses spend about an hour washing and turning the patient in bed. They work carefully so that the cables and plastic tubing stay where they should be.
This is Pauline Reynier’s first assignment as a new intensive care nurse. He is on his second shift at the department and has to learn while working. His colleagues have barely had time to learn his name.
Those who work here run the risk of contracting the same disease as the bedridden patient.
RISK: The risk of infection makes work in the intensive care unit more challenging. Photo: AP
So, in addition to the tasks Reynier will learn, infection control routines should be incorporated. First, he puts an apron over his uniform. Then a pair of gloves. Make sure they are fully snug around the wrist. Then a new pair of gloves. Then he puts on a mask, glasses, and finally a new plastic apron.
Header cabal
In the morning, doctors discover that the rooms of the new intensive care unit are not equipped for the dialysis machine that a patient in a coma needs. He must be transferred to the usual intensive care unit. It is about 25 meters away and fortunately another patient recovered enough to be transferred to another room.
Doctors and nurses find the equipment they need. Moving the 60-year-old requires 14 employees and 45 minutes of preparation. They start the movement at 10.40. A quarter of an hour later, the patient is in his new room. The back of Reynier’s blue nurse’s uniform is drenched with sweat.
There is now a bed available in the room.
See when death is near
Around lunchtime, doctors rush to the room of a 54-year-old patient. The man was conscious in the morning, but now the oxygen level has dropped. You must be anesthetized and intubated.
– We must help keep them alive while the body heals. But intensive care is difficult. Not everyone survives, says Carvelli.
ACKNOWLEDGE DEATH: Doctors and nurses know more about the course of the disease now than they did during the first wave. Photo: AP
After watching many COVID-19 patients die, doctors now know the course of the disease well enough to recognize the signs of the end-stage. That’s good, because then families can come to the hospital to say goodbye.
Must refuse sick
During the day, several hospitals have contacted La Timone to find out if they have intensive care units available. Dr. Fouad Bouzana, who is in charge of the beds, has rejected all of them.
“I have to have a bullet in the chamber,” Bouzana said.
When night falls, colleagues call the emergency room and say they have brought in a man infected with corona. Bouazana still strictly protects the last place in the intensive care unit. He asks his colleagues to examine the man carefully and possibly contact him later.
PROTECT THE BEDS: Not all patients with coronary heart disease are admitted to the intensive care unit. Photo: AP
Two more patients are turned away overnight. Bouzana believes that they are too old and weak for intensive care.
They must stay in the emergency room, hoping the condition will improve. But Bouzana doubts it.
– Doctors should discuss which patients we should host. If one of us wants to receive a patient, we always accept the patient. Although the others do not agree. But overall, we agree, he says.
And as a new day is on the way, the man who came to the ER the night before is taken to the only available bed.
La Timone’s intensive care unit is full again.
