‘Death is becoming commonplace.’ The stories of two women working on the front lines against COVID-19

Amanda approaches the patient’s ear and whispers: “Don Marquito, please breathe. Listen to my voice.” It is uncertain if he listens to her. She cannot answer him with words or gestures. He is sedated. The only ones who can give an answer are his vital signs, whose record is kept by the noise of the machines and the vibration of the fans.

Amanda is a respiratory therapist in the intensive care ward of a hospital belonging to the Ecuadorian Social Security Institute (IESS) in Quito. She has worked on the front lines since the first wave of the pandemic. She and an emergency specialist from an IESS hospital in Guayaquil recounted the grief, exhaustion and shortcomings that health personnel suffer caring for COVID-19 patients. They did so by reserving their names to guarantee their job stability. We’ll call them Amanda and Isabel.

Isabel is tanned by tragedy. Before working as an emergency physician, she worked in the intensive care unit of a public hospital in Quito. She has been fighting the coronavirus for almost two years. When she remembers her patients who have died, her tone becomes sad. “The death, pain and suffering of families is becoming commonplace and, over time, we have realized that this does weigh us down, it burdens us”, he laments.

Figures from the Ministry of Public Health (MSP) show that the number of patients with COVID-19 in intensive care areas increased unusually at the beginning of this year and reached its most critical level in the last days of January. It occupied between 70% and 80% of the intensive care units (ICUs) available in the country, something that had not happened since mid-2021.

There were hospitals that reached the limit of their capacity, with all the ICUs occupied. That happened in the hospitals where Amanda and Isabel work. They were very hard days for them and their companions.

Health personnel shifts demand many hours of work, even more so when they care for patients with COVID-19 who must be under permanent surveillance. every four days, Amanda works 24-hour shifts straight, which he shares with nine other therapists with whom he organizes himself to take care of the two ICU rooms for patients with this disease. “There are shifts in which, if we manage to sleep three hours, it’s pure luck (…). We end the shifts with headaches, feet and legs, in addition to mental fatigue that is strong, ”he says.

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At the beginning of February, ICU occupancy began to decrease in the country, according to official figures. However, there are those who entered in past weeks and have not yet managed to recover.

Isabel has felt that decline. She says that in the last week there have been no new admissions at the hospital where she works. “It is like a hopeful light that makes us think that this wave is passing”she says encouraged.

However, the long hours have not stopped and that is not the only problem for health personnel. Isabel says that, at the beginning of the pandemic, wearing the biosafety suits was quite a challenge at work time. “It was terrible to be covered from head to toe. She could not breathe well, the heat was unbearable. Just going to the bathroom was almost impossible, ”she says.

Today, with more knowledge about biosecurity measures, Isabel assures that her routine in the hospital is a little more bearable. She changed the heavy white suit for her characteristic doctor’s coat, a hat and the inevitable N-95 mask.

Work sick caring for the sick

Something Isabel and Amanda share is the concern that, whether due to illness or layoffs, there will be fewer staff and your workdays become even heavier than they already are.

Amanda says that, at her workplace, a large part of the health personnel was infected with coronavirus in January. However, they had to continue working despite the physical discomfort caused by this disease.

“We have been left with consequences, such as joint and muscle pain, cough and more, but even so we had to continue working because there is no staff to cover our shifts and not all hospital staff are trained to work in this area,” he complains.

Isabel agrees with this and points out that several of her companions have had to do their sick shifts. “The infected obviously work in the COVID room”he says thinking about the irony of being sick while curing the sick.

“We have had to come to work despite discomfort, fever and fatigue. We have had to work like this because, if not, there are empty spaces in the shift and that makes the work heavier, ”she says.

By the way, the Pan American Health Organization (PAHO), in a statement issued on January 13, rescued that “The pandemic showed the wear and tear of health personnel and in countries where the health system collapsed, staff suffered exhausting hours and ethical dilemmas that impacted their mental health”.

Given this, PAHO recommended the urgent development of specific policies that allow organizing protection actions for the mental health of health personnel.

In addition, he suggested modifying the work environment so that adequate working conditions are guaranteed, as well as grant decent remuneration, stable contractual conditions and the creation of spaces in which the teams can let off steam and practice self-care.

This newspaper requested an interview with the MSP to find out what measures have been taken in public hospitals, but there was no response.

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The psychotherapist and director of the Casa de la Familia Foundation, Patricio Santamaría, says that work overload can trigger Burnout or burned syndrome.

In psychology, this term refers to the chronic stress people experience from being overworked without job feedback or rest.

The consequences could lead those who experience it to develop extreme physical and mental exhaustion and, over time, could produce a personality change, adopting an attitude of indifference or detachment, as well as irritability and difficulties in handling frustration.

Santamaría specifies that this, in the future, “can have repercussions on a decrease in labor productivity and being physically and mentally exhausted, they will not be able to do an effective job.” This warning is critical in professionals whose performance lives depend on.

Grieving for patients

Dealing with so many deaths took a toll on Isabel’s health. “I could not sleep, I was not hungry, I lost weight, I felt bad and I had a bad temper constantly (…), because although we have always had critical patients, they have never been of this type, so severe and with such a risk of death ”he laments.

On this same topic, Amanda says that when patients fail to recover, she feels deep sadness knowing that a family lost someone and that this person died alone, because “unfortunately, no one can enter the intensive care area to keep them company.”

“It is very hard to live this. When a person dies holding your hands, when after they intubated him he asks you to promise him that he will get out of that bed, of that room. When they ask you for a video call to say goodbye to their family because they know the end is near. Know that that person has children, parents, siblings. This is really hard,” she sobs.

The idea of ​​facing death has peculiarities that depend on each human being, says Patricio Santamaría. He explains that, despite knowing that we are finite, no one is prepared to lose a loved one, in any context.

The duel, maintains the specialist, is not something that only family members experience who has died; also those who have created ties with him, no matter how short the period has been. That happens to health personnel. “A bond is created and in the doctor’s imagination it is that he has to be able to save his life and, when this is not achieved, there is a loss and therefore a duel”, he explains.

Santamaría warns that the constant exposure of health personnel to mass deaths and the series of mourning for lost patients, added to not prioritizing their self-care, can be a ticking time bomb that could trigger chronic stress that even cause physiological effects.

According to PAHO, Ecuador is among the countries in which at least 10% of its health personnel were infected with COVID-19. This, indicates a statement published last week, “has led to elevated rates of depressive symptoms, suicidal thoughts and psychological distress.”

For Santamaría, it is essential for health personnel to go to therapy as it is a tool that, in addition to serving as an emotional discharge, helps to understand oneself and the way one perceives the world.

Amanda and Isabel do not know each other. They work more than 430 kilometers away from each other. One in Guayaquil, the other in Quito. Despite this distance and never having worked together, they have experienced the harshness of the balance that COVID-19 has left in its wake and both, despite being aware that the road is uphill, they share the idea that when they manage to save someone’s life, all their work has been worth it.

Isabel feels that when a patient manages to get out, it is the most wonderful thing. “They wake up disoriented, they don’t know where they are or what happened. When the tube is finally removed, the most beautiful thing about them is that they don’t think about themselves. They usually ask about your family. They always think of their family,” he says. For her, being able to be part of that is the most beautiful thing about her job.

Amanda reminds her patients that they were intubated for several months and managed to save themselves. Days later, she was told: “You can’t imagine, I can comb my hair now”; “I can now go to the bathroom by myself”; “I already left the oxygen”; “Today was the first day that my body didn’t hurt”; “I finally walked more than two meters without gasping for breath”; “Thank you, for your help I’m still here and I’m back with my family.” Those achievements are what give him the most joy and pride.

“That is what has made me continue standing, that I continue going to work with all the enthusiasm in the world and that every shift, minute by minute, I try to get the patient to leave. All these factors have been my engine to be able to endure this, ”she says with a noticeable mixture of satisfaction, nostalgia and joy. (I)