In the intensive care units of the city’s hospitals, doctors and nurses have been fighting the corona virus day and night for over 14 months. Insights into a stressful everyday clinical routine in the intensive care unit in the Vinzenz-Pallotti-Hospital in Bensberg.
The patient lies motionless on her stomach, her dark hair can be seen, her eyes are closed, her left arm is stretched out on the bedspread. You’d think she was just sleeping soundly. If it weren’t for the many cables and hoses that run from your body to devices and IV stands. The many small monitors on the infusion pumps with small and large numbers show that a struggle for survival is raging inside, it is being fought in the organs and vessels. So that the 75-year-old woman could be ventilated through a tube, she was put into an artificial coma, a type of permanent anesthesia. Francesco Cardone, Head of Intensive Care, bends over the patient’s “curve” outside the room – a sheet of paper that is meticulously documented several times a day how the patient is doing and what she is getting. There are nine drugs in total. “That is still relatively little,” says Cardone. Three anesthetics, antibiotics, insulin, cortisone, circulatory support and of course oxygen.
The woman in the room cannot tell how she is. “We have to think along for our patients,” says Thorsten Löhr, chief anesthesiologist. There are no therapeutic means to prevent the fatal lung failure so often caused by the virus. “We don’t really know what to do. So far there is no proven path, ”says Löhr. All sick people have the same virus. Nevertheless, each case is different. “The course is unpredictable.” About every third Covid patient dies in the intensive care units.
“Caring for Covid 19 patients is a very stressful job”
The anesthesiologist attributes the fact that there are now very few very old people with a corona infection in the clinic primarily to the vaccinations. For this, younger people, mostly 60 and 70-year-olds, are now lying on ventilators, sometimes for weeks or even months. Their resilience is simply greater than that of very old people, explains Löhr. But no patient should have been turned away yet. The Gladbach clinics all worked together: “We regularly discuss what it looks like and who can still take patients.”
The workload in the team in the intensive care unit of the VPH is great. Four doctors and a total of 40 employees, including service staff, have been working with corona patients since March last year – continuously, day and night. There are currently four patients with a corona infection – three men and one woman – on the ward, all of them are civil servants. “More is not possible,” emphasizes Löhr. The other beds – there are ten in total – are currently also occupied except for one, with patients who have had a serious tumor operation or a heart attack.
“Caring for Covid 19 patients is a very stressful job,” says Löhr, “it’s often an up and down.” The disease has so many tricks. Hardly does it seem like things are going better than the values deteriorate again from one moment to the next. But the care is also extremely physically demanding: “This is high-performance sport.” Four people alone are needed to bring the limp body into the prone position. “So that the lungs can be better ventilated from the back,” explains Löhr. Every 72 hours, the unconscious patients are then turned on their backs for some time so that there are no pressure points.
Struggle for normality
It takes a while for Beate Chwalczynski (49) to get dressed to enter a room in which Covid 19 patients are lying. An FFP2 mask with a visor on top. A blue cap for the hair. A yellow water-repellent protective gown and three pairs of gloves on top of each other. The intensive care nurse takes over all the things that people would otherwise do at home. “Wash, brush your teeth, comb your hair,” counts. She is just going into the room of the woman with the dark hair, her yellow smock rustling. As she bends over, she greets the patient despite the coma, says what kind of day it is today and what she will do next. With all the technical possibilities, in their opinion nothing can replace compassionate contact. In this way, however, Chwalczynski preserves something like normalcy for himself. “Besides, you’ve heard of coma patients remembering voices later.”
“Sometimes we are in the rooms for three to four hours,” says Eva Mollerus (25), “after that we are always soaked through with sweat.” Just going out in between is not allowed. Even taking off the mask to have a drink is not possible in order to prevent contact with the virus. Sometimes she drinks a whole bottle of water before the shift, “so that I can already have a drink.” For Mollerus, giving up is not an option. “Thats my job. And it’s great to see how patients leave the intensive care unit after a long period of treatment. ”Fortunately, everyone on the ward has now been vaccinated, so the fear of infection is no longer so great. “Personally, I am particularly encouraged by the fact that we work together in a great team and exchange ideas about problems.”
As Head of Intensive Care, one thing is particularly important to Francesco Cardone: “That the working conditions are good.” This also means that the night shift is always manned by four employees. That aids such as special abdominal pillows were purchased to position the sick so that there are no pressure points.
Relatives are informed about the condition every day
The fact that they have to work in thick protective clothing, that they often have to turn heavy patients, is not the worst thing for the nursing staff. “It is very close to us to see people lying there so completely alone,” says Mollerus. Everyone on the ward is sorry that the relatives are not allowed to come. Visiting is prohibited. A single unrecognized infected person would paralyze the entire station. Every day the families are informed about the exact state of health with a phone call, as often as possible a connection is established via video so that the situation becomes more tangible.
The exchange with relatives is important for another reason. “It has to be decided together how to proceed with the therapy,” says chief physician Löhr. Which life support measures are still possible? Are there advance directives or clear ideas about her death?
Beate Chwalczynski has been a nurse for 32 years and an intensive care nurse since 2010. In the short Corona period, she has seen more people die than in the many years of work before. There are now exceptions to the ban on visits if the patient is actually dying. But it often happens very quickly. Then the team becomes a family replacement. “I only recently held a man’s hand when the moment came to die,” she says. Then she turns her head away, tears run down her cheeks.
Source: Kölner Stadt-Anzeiger – Kölner Stadt-Anzeiger by www.ksta.de.
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