It is a raw, unrestrained dive, moving in many respects and chilling in so many others, in the daily lives of doctors, on the front line facing the Covid-19 epidemic.
An intern in an intensive care unit in Île-de-France gave us access to his logbook started in mid-March, just before the implementation of containment measures. After two weeks of storytelling, reflecting a vertiginous situation where the worsening of the health crisis was taking shape under his pen, he delivers his third week here at the front.
Between a replacement in a regional hospital, which is experiencing the epidemic with a delay and its role in its resuscitation service in the Ile-de-France region, it experiences "the roller coaster", as the condition of its patients deteriorates. When we left him, this thirty-something doctor, who prefers anonymity, was struggling between thin hopes of favorable outcomes for some of them, including a young man under 25, an accumulation of deaths and the news of one of his former teachers' hospitalization in intensive care. On the 15th day of this diary, he was still a replacement in the emergency room of a hospital 300 km from Paris.
Day 15. The wave arrives elsewhere too
Waking up is hard this morning. But the colleagues I am taking over from had a good night. The patient of yesterday, unstable, is in intensive care and intubated. Two patients arrive in quick succession. The first had a septic shock. She has cancer, we will not resuscitate her, but she must be hospitalized. There is still a place in palliative care. This does not mean stopping, we will continue to support it. That's what I explain to him.
I eat in 10 minutes. Arrives a patient, 57 years old, diabetes, obesity, polypnea (increase in the respiratory rate), a profile to be admitted in intensive care, but they also begin to run out of space here too, they have already served as load shedding zone. It's going to be tough for them. Strange flashback, I already experienced this situation in my service in Île-de-France.
Before leaving the emergency room, I manage to get all my patients out. Back at the hotel, empty and huge. The neighbor sends me pictures of the cat. My nursing mother also feels alone, we are called. Then, I work on the interns' schedules. Usually I like that, but there is a work overload until midnight.
Day 16. Do not wait for recognition
In the emergency room, it almost looks like a normal day. We are 50% of the usual crowd. One of the chiefs calls us: one of the oldest doctors in the department, exposed in Covid units for 10 days, is diagnosed positive. She asks me to take care of it. My "VIP" is coming, I don't like this word, but it is an authority on the local medical world. He's not bad, he doesn't have a big Covid ( big symptoms of coronavirus ), but maybe a little heart problem. It'll do it for him. We watch it like milk on a fire.
Back in the area. No new patients. A colleague suspected of being Covid comes to be tested, I take our external to teach her. While I think about it, we, the interns, we're going to be had in style. Our additional investment in this crisis will not be rewarded financially, unless we are requisitioned. I'm pissed off. Anyway, the job is there, we will be there. But we should not wait for recognition, just applause.
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I make my transmissions, day over. My hands are chapped after three weeks of intensive washing, when it took my mother, nurse, 30 years to have eczema.
Day 17. A night in the emergency room, between patients of all types
I'm going to work 24 hours in the emergency room. It's been a long time. I like to work there at night. I first find myself on the non-Covid circuit, with normal patients. It feels good to think differently. We do emergency medicine under ideal conditions: we take care of patients quickly. Psychiatric patients decompensate with confinement. Like alcoholics. There too, there will be damage.
Just before I start my night in the Covid sector, a patient has a heart attack. A rush of adrenaline, you have to be quick. During transmissions, I recover the most serious Covid patients. One of them gives the change but presents the most disgusting scanner I have ever seen: 90% of Covid damage in the lungs. The resuscitators are called: he has his safe conduct for their service in the event of aggravation. Hypertension, diabetes, obesity ... We pray for him that he will never be intubated. Call the family, I strongly advise them to call the patient before ... They understood that it was very serious, too.
Meal, a little kawa and off we go. The last patients are discharged and hospitalized. Empty waiting room. I find the bed in the guard room, collapse. My intern had two patients to manage, but will not wake me up for the few hours that separate us from dawn.
Day 18. Return to Île-de-France
End of guard with an eye on Facebook. Conspiracy theses galore, it's tiring as soon as I wake up… I leave the service, return to the hotel, then head to Paris. Tomorrow I'm going back to my intensive care unit. I'm a little scared. But there is little hope: our young person under 25 is waking up. There is bad news too. A good friend, an anesthesiologist in a teaching hospital, tells me that they have no more drugs left. My department head calls me. We are going to reorganize everything again and we have a reinforcement of interns. It will do good.
Day 19. Rollercoaster in the service
Return to resuscitation. Three patients were evacuated yesterday. Another, who entered early in the morning, is being intubated. One man died, cardiac arrest and Covid-related acute respiratory distress syndrome. 40 years old, dramatic. The family will arrive. Back in fanfare in the service. I didn't miss it.
During the morning visits, one of the first five patients was suspended. Another is extubable (intubation can be stopped) . Hope. A third is in a catastrophic respiratory state. Russian mountains. Another is better. Medical looping. The young boy under 25 made a new stop during his helicopter transfer to another center. His heart is gone, but it's blasante ...
Planning meeting, we will have to assign to this "service" two internal, autonomous. Six months ago, it would have been unimaginable. There, it's just normal. With yesterday's evacuees, we have a little room. Beds are empty this morning, so strange. But everything will fill up today. A hundred Covid resuscitation places remain in Île-de-France, not enough for 24 hours. My friend, an experienced emergency room doctor (from whom he learned hospitalization in intensive care last week) is deteriorating. It is transferred to ECMO (a respiratory and / or cardiac assistance technique based on the principle of extracorporeal circulation) . A last chance technique. Spontaneous tears, it's good to cry.
Day 20. Cogitations, among other resuscitation scenes
Dirty night. My friend in intensive care had the right to access an ECMO because he is in the region. In Paris, that would have been nonsense for him, the criteria are more restrictive. We are not equal in the face of the virus. Reinforcements arrive from the provinces. Nice for the AP-HP teams. But the hospitals in the great crown are not as well endowed.
PODCAST. "We are not prepared for this!" »: Léa, 26, medical intern, facing the coronavirus
On arrival in the department, we see the helicopters land on the tarmac to transfer the sick. The two patients who may need intubation must be scheduled. Come home a little earlier. I will be able to rest before the call this evening at the clinic. Quiet night in the emergency room. Too much time to think. In bed impossible to sleep.
Day 21. Good news, finally. But not only…
The alarm rings. 5 hours of sleep and 15 hours of work to come. The Guronsan is going to be my best friend. We have a patient who has been extubated for 2 days. Another died during the night. In a third patient hospitalized yesterday, his brother died of Covid, his mother too, his father is unstable and his sister also contaminated. A 22-year-old girl leaves intensive care. My God it feels good. We continue to transfer patients, but a little less than last week.
One of my patients of the day has been there for three weeks. She is 65 years old, almost the dean of the service. We are going to extubate him today. His neighbor too. A resuscitation room with two awake patients! What a balm to the heart to see them both sitting, even if there are risks. I enjoy calling their families. Give good news, share it with their loved ones after so much time to temper things ...
We have a new entry, a young person, we try the Boussignac (a respiratory assistance technique based on the wearing of a mask) , failure, we will have to intubate it. I'm trying. For a few days I have not been able to do it, a bad series, my boss is there, he succeeds at the first try. Rageous, but so much the better for the patient.
Pause to report, this part that many hate, but necessary. When I get out my colleagues are resuscitating one of our patients. A youngster, a cardiac arrest. I'm transferring someone. When I returned, the colleagues were killed. The young patient died. Her heart stopped three times. The arms fall. The tears flow. Another death from the virus. Back home, I share my can of sardines with the cat. I'm not hungry. I pull my quilt.
