When called in the early morning, he comes out of a long night of intervention. "I'm still living on adrenaline, but I'm going to collapse soon," smiles Jean-Marc Agostinucci. This doctor with a solid career, an emergency doctor at Samu 93, in Seine-Saint-Denis, works with the heaviest patients on Covid-19, whom he transfers from their home to the intensive care unit.
This great terrorist specialist never worked in such circumstances. This results in a loss of luck for all patients, because "without this virus, we could do much more for them". But also increased risks for caregivers: “With fatigue, we tend to focus as much as possible on the patient and forget ourselves. "
What are your working conditions today?
JEAN-MARC AGOSTINUCCI. We are in maximum tension with continuous pressure, guards of sometimes 36 hours without sleep and increasingly limited means. The worst part is the lack of protective clothing that is worn when in contact with the most serious patients in Covid. Given the shortage, I don't even know if we will hold the week. We already have to reuse our protective glasses, which we wear when intubating a patient, when they are for single use. After three times, the plastic is destroyed. Not to mention that there are no staff to decontaminate the ambulances. After each intervention, we clean ourselves, for 45 minutes, the interior of the vehicle, the stretcher to the door handles with a rag in bleach.
Can you manage all the infected patients in the department?
For now, yes, even if the response times are getting longer. The most problematic are transfers. For the past six days, resuscitation services have been saturated in Seine-Saint-Denis and the surrounding area. A platform has therefore been created to identify the rare places still available in hospitals in Ile-de-France. But it sometimes takes an hour and a half for us to be told, at the other end of the phone line: "It's good, I have one!" Meanwhile, the patient is started to resuscitate inside the truck using a small portable ventilator. Sometimes the hospital where there is a place is for miles and miles, up to two hours round trip. If we are called at this time for a heart attack, we cannot go! It's disaster medicine.
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PODCAST. "We are not prepared for that," Lea, 26, a medical intern.
Is there a loss of luck for the sick?
Of course! If a person in a nursing home is infected, we will choose end-of-life support rather than transporting them to intensive care. It's sad, but we have to sort it out according to age, state of health… We are also starting to run out of curare, an essential substance that serves to relax muscles when we intubate a patient, heavy and risky gesture. This means that less effective resuscitation will soon take place. All patients, Covid or not, have a loss of luck. Without this virus, we could do much more for them.
How do you feel in the face of such an observation?
After guards like the ones we are living in right now, we need to empty. There are medico-psychological cells, mine is my wife. We also listen to friends the next day, knowing that we will live the same day as them. I am an old doctor, I learned to protect myself. But for the youngest who land on the ground, it's very hard to live.
By dint of chaining the hours, do you make mistakes?
The more we work, the more we take risks, above all for us. Sometimes the doctors do so many interventions that the trucks do not return for 24 hours to the base, located at the Bobigny hospital. Or the doctors just come back for a bite to eat. With fatigue, we tend to focus as much as possible on the patient and forget ourselves. We think less about putting on gloves, outfit, charlotte. It is for this reason that there are so many infected caregivers.
What type of serious coronavirus patients do you see?
Mainly the elderly, people with respiratory or obesity. We also sometimes see younger people. I even saw one of 26 years old, with no medical history, whom I took to intensive care. He was in very poor condition. I did not expect to see a kid. My 25-year-old daughter-in-law also has coronavirus. So, inevitably, it trots a little in the head. My first reflex in the evening was to call my son to hear from him.
Are you going to keep up this pace?
For me it will be fine! I am 30 years old from Samu. You know, I was still a student when I made my first big intervention. It was in 1988, 53 dead during the accident at the Gare de Lyon. I made all the attacks of 1995, the accident of the Concorde, the big deadly fires of Aubervilliers in 2013 and 2014. I am a specialist in attacks and chemical and biological risks. My family is worried, but I will hold on. I don't have time to have moments of depression.
You piloted operations at the Stade de France during the attacks of November 13, 2015. How is the care of coronavirus patients different?
The real difference is the duration. I have often treated victims of gunshots or explosions. Seeing the injured Stade de France, necessarily, we are a bit stunned. Then everything is set up extremely quickly, we do everything we can. Five wounded remain, then two, then one. The number of patients is fixed, we know we will get there. All will go to intensive care. There, nobody knows when it will stop. We are also fighting for a patient with Covid to have a place in intensive care. When you have one, you say to yourself: "Above all, another Samu must not take it from me!" It is a race against time and against one's own colleagues. We arrive there… We say to ourselves, today I had one, but tomorrow? My anguish, there it is.
