Emilia vexler
05/15/2021 4:18 PM
Clarín.com
Society
Updated 05/15/2021 4:27 PM
Amid the bustle of the second wave of coronavirus in Argentina,
intensive therapy is the quietest place
that today can be found in a clinic or hospital.
But silence is only the absence of a human voice.
There is a vital apparatus orchestra there.
Some people, very few, are lucid in this area.
Most are intubated.
They do not listen to the devices to which they are connected.
They don't even hear the
electronic
"
pi pi, pi pi
" of their heartbeat.
They don't listen to the ventilator sonata.
They do not listen to the voice of the doctors.
It is nothing more than the loneliness of a bed and the company of a virus that is already in the lungs and blood.
That rules in that intensive therapy.
Before the voices stop, before entering therapy, there is that moment, noisy,
in which you hear "We are going to have to intubate you
.
"
There may be a time to be able to call the family or, if you cannot because you have an oxygen mask with a reservoir (which patients call "elephant trunk" and are very uncomfortable), send them a WhatsApp.
In other circumstances, letters are even written or video calls are made that, although it is hard to verbalize,
are in a farewell tone
.
But there are also those moments when there is no time for anything.
Silence comes suddenly.
Like sedation.
Clarín
collected stories from patients who were able to "get out" of intensive care after overcoming Covid, and
want to leave a message for those people who, at this moment, cannot hear anything
.
Also those of heads of intensive therapies who describe the reactions of a limit moment.
Last message
“I just want 30 lucid seconds.
To be able to evoke those I loved without being caught by melancholy.
I'll be fine
”.
That was the most emotional phrase in the farewell letter from a Conicet researcher before dying from coronavirus.
On April 12, Hugo Miguez, a doctor of addiction psychology, was able to write a message on his cell phone before he was intubated.
He passed away eight days later.
He was 75 years old.
Hugo Miguez, a psychologist and researcher at Conicet, wrote a moving letter before he was intubated.
He passed away eight days later.
He managed to say goodbye that way.
Sergio De Benedictis, 52, was intubated twice for coronavirus in the first wave, in June, and tells
Clarín
that he did not have the same privilege.
"I couldn't have any communication,
I remember it as if it were a dream
. It seems to me that I fainted, and I remember Pablo's word telling me 'We have to intubate you'. And I told him: 'Do what you have to do'" , He says.
He is a fruit producer, works in the Central Market, where he was infected, and could not "even send an audio" to Mateo (22), Martina (19) and Renata (16).
Nor see his wife.
"I felt really bad. We were dependent on the weather. I couldn't say goodbye. It was very hard. I didn't even have time for things to cross my mind."
Sergio de Benedictis was intubated twice.
He managed to get ahead.
Photo Guillermo Rodríguez Adami
"Pablo" is Pablo Pratesi, the head of intensive care at the Austral Hospital.
Sergio did have "the luxury" that whoever treats him and gives him this news is his friend for 12 years.
But the virus does not know of links and Sergio, who saturated between 89 and 90, had a very bad response to plasma.
"I started coughing and coughing and coughing. I couldn't breathe and there they intubated me. The first time I was asleep for seven days, I went out, I was awake for three days in therapy and then, already very bad, due to a Covid complication,
they intubated me again 12 more days
. My wife tells me that apparently there I had a video call and said goodbye to my family. I really don't remember it. I do remember the dreams I had while I was intubated. And when they wake you up, you get mixed up with what happens. in real life, "he narrates.
It is not the first time that someone who was in an Intensive Care Unit (ICU) refers
not to distinguish between the dreamlike and the real
.
Or you have gaps or forgetfulness about situations that seem indelible.
Pratesi sees it frequently and describes other sensations "forgotten" by the people who remained in that silence.
Patient reactions
"Doc: Mr. does not want to intubate ... he can't take it anymore. I put on my diving suit. It's hard for you to hear me. You snort with difficulty. I look you seriously in the eyes. Ok Doc. Whatever you say. You call the friend of the soul. Papers are there. Take care of the skinny one. You knew you weren't telling it. My lump in my throat. "
This tweet is part of a moving Twitter thread from intensivist Vanina Edul.
With different heartbreaking cases, it was retweeted more than 2,500 times.
These are stories behind the numbers.
We discuss whether the lethality is 2.47 or 2.74.
Politics and medicine collide head-on.
32 years old, diabetes well controlled.
You took care of yourself.
Now you're in O2 mask, just thinking about the next breath
- Vanina Edul (@EdulVanina) April 25, 2021
What is that time prior to intubation like?
"Unique. You have to tell them 'Look, with the way you're receiving it now, you can't get enough air to oxygenate well. So we have to sleep you, to put a tube down your throat and connect to a respirator. It's a very hard moment. But also vital. It is important to explain it to them. That it is not a mechanical thing. That it is a very human moment, so that, if they have the possibility, they can talk with their loved ones. Tell them what they feel ", Pratesi details.
But it also has to go technical.
That, if they wake up, "do not bite or fight" the "tube" that they have in their throat.
Something that can be very dangerous.
"Some people are willing to ask for a priest, a rabbi or someone who can cover them from the spiritual point of view. For the medical team it is very important to be able to allow that when they have the possibility to do so. they can have that moment, due to the urgency, the emergency. In that case, our care is because they are well sedated and have good analgesia. "
Pablo Pratesi, head of intensive care at Austral, says that the patient must be explained what is going to happen.
Photo Juan Manuel Foglia
What about families?
With those people who are on the side where the noise is.
As described to
Clarín
from the ICU of the Güemes Sanatorium, as well as people are "prepared" by telling them the next steps if oxygenation drops,
the situation is also being raised to relatives in the telephone reports.
That they are between 10 and 12 noon.
If something bad happens, it is notified regardless of the schedule.
In Sergio's case, "the bad", the first intubation, was at dawn.
Among the anguish of the families, he focuses on those who are going through "asleep" serious pictures of Covid.
"I would leave the message to them that this is a disease in which you are alone, which is very hard. You need family support to recover as soon as possible ... but you
have to draw strength from where there are none and move forward
. It is the challenge of life. And when you wake up, to continue fighting it. I spent a total of 35 days without being able to feed myself on my own. I learned to eat again and without hunger.
Sergio even today is more tired than before, he is agitated a lot and he lost strength in his legs.
At the time of infection, they did not have any pre-existing disease.
Today he eagerly awaits his place in line to receive the vaccine.
The intensive care unit of CEMIC.
Photo Luciano Thieberger
On the family side, it must be remembered that once someone is admitted for coronavirus, clinics or hospitals become
strong
health facilities.
Insurmountable walls until discharge from the clinic.
The cell phone is not enough and
the "last hour of connection"
, when you are in the common room, becomes a kind of double-edged party.
"He hasn't been connected since yesterday, will it be wrong? He didn't read me the message. He doesn't answer me and at this time they already brought him breakfast. Can't he stop to connect the cell phone?"
In therapy there is no cell phone.
There is no breakfast.
There are no televisions to distract you.
There are intubated people.
They can be in single rooms in shared rooms.
A procedure that saves lives
Endotracheal intubation is a
high-risk
invasive procedure
- the tube in the throat discussed in these paragraphs, plus the machine to help air in and out of the lungs.
Mortality can reach 50% among those who reach this stage
and, at a minimum, it extends the hospitalization.
It is only indicated in seriously ill patients due to Covid.
And it is not exclusive.
It depends on the vital signs.
There is no average length of this income.
But the experts consulted in this note agree that
being intubated for more than 15 days can worsen the prognosis
.
Think about the family
Marcelo Fernandez (44) lives in City Bell and received a positive result on April 18. He is hypertensive and has hypothyroidism. He was infected during a working lunch with a colleague from the Sutcapra union, a watchdog. It started with a persistent fever - "Not very high, 38.5º" -, cough, low saturation and bilateral pneumonia.
Six days later, he was intubated.
"Two days after hospitalization, I could no longer make any decisions. I don't even remember those first two days.
I started to lose consciousness
, they do another CT scan and the therapist on duty decides to intubate me. When I wake up, he tells me: ' Do you remember me? I am the doctor who decided to fall asleep. Before I told you that you were going to recover well. And look '", he says.
But he does not remember and even today he cannot retain that name.
Marcelo Fernández was not conscious at the time of his intubation.
"So imagine I couldn't do anything before they put me to sleep. I couldn't talk to anyone."
He only remembers that he begged his sister, who is a nurse, not to intubate him:
"I knew how traumatic it is for the family
.
"
Marcelo was intubated for five days and his wife received a daily call.
He woke up with doctors, technicians and his sister.
He also does not remember hearing appliance sounds while asleep.
As soon as the sedation subsided, he made emphatic gestures for the tube to be removed from his throat.
A few days after that opening of his eyes, he is still short of breath, but he has a lot to say to those who may be going through the same thing he left behind today.
"It is very difficult to speak to these people because most of them are not conscious. In that silence. But I would tell them that it is an extremely cruel disease for having to be so bad and isolated. But that they seek strength from within.
That they perceive that there is people who love them, who are waiting for them.
Let them try to get out of that place quickly. From that absolute loneliness, "he closes.
A week later, Marcelo was discharged from the San Martín de La Plata Hospital.
The protocol
Rosa Reina is the president of the Argentine Society of Intensive Care (SATI).
When asked if there is a protocol to give the worst news to patients, he says no.
Firm.
The protocol, like the infection, is on a case-by-case basis.
"You get to know the person, you get to know how to talk to him. You have to build trust in the procedure you are going to perform. Many times people arrive very badly, short of breath and may be aggressive, kicking, yelling, that they do not understand you "They have this attitude due to lack of oxygen in the brain. Or they may have impaired consciousness due to hypoxia. There is not much to talk about. It is intubating and then talking with the family," he explains. The "desirable" time is to be able to speak before sedation.
"When we can, we tell him that the painting is deteriorating, we put a mask on it - the 'elephant trunk' - and we tell him why. In that case, then we show them the tube. We say 'I'll go to you. put the tube, it will not hurt, we will be with you controlling you. You will wake up with the tube.
Some cry, others do not understand.
But family members are a great support. Not all professionals think alike. But I believe that if the family member can be up to the moment of intubation, it is very well, "he clarifies. Reina leads the team at the hospital where Marcelo was admitted.
"There are colleagues who do not talk about death, but I am more direct.
And in intubation I tell them that it is to save their life.
The different thing is that people with Covid, even if they are well, know that they can end up in therapy and even die. Then it is very different and they tell us that they want to say goodbye. They tell us 'Write this to my son', 'Tell this to such'. This used to be seen only in terminal patients. And there was the family. .
This is the most poignant of those infected.
they are delivered. Make a log of that is happening. When they can ".
In intensive care, then, there is silence, there is loneliness.
There is inanimate noise.
But there is the company - literally invasive - of those who care.
Permanent vital controls, blood draws that do not drop twice a day.
The only noise, beyond the respirators, is that of
the vocation to save lives
.
In the end, everything rumbles in this area.
The quietest in a hospital or clinic.
ACE