Maria Bethlehem Etchenique
07/02/2021 6:02 AM
Clarín.com
Cities
Updated 07/02/2021 6:02 AM
Silvia Bustos needed others to get sick to understand that no, it was not her fault. That the coronavirus had not entered his house because one day he badly washed his hands. On July 1, 2020, she and her husband fell ill. For a long time he was careful to think about his life and his decisions. She had chosen to be a doctor long before this, but the consequences of that long-ago will tortured her. It took weeks, months and for his colleagues to also get infected so that this internal monologue would stop bubbling in his head: "I didn't take care of myself. I got distracted. The mistake was mine and my family is paying."
At the time of their infection, another 64,530 people in the country - today there are more than four million - had had the virus. Three months had passed since the start of the pandemic but the routes of contagion were still unclear. Men and women concentrated more on disinfecting doorknobs, keys and supermarket products than on ventilating rooms. The importance of breathing someone else's air was still unknown. And as the head doctor of one of the Covid-19 rooms, Silvia worked inside a fish tank full of invisible viruses, initially dressed in overalls that were not discarded but instead sprayed with disinfectant and used again the next day, due to
lack of personal protective equipment
. But she did not stop at that and preferred to take responsibility, not knowing what she had done wrong.
"I understood later, when I stopped being one of the few infected and the same thing began to happen to my colleagues: nurses, nurses, physical therapists, physical therapists, clinicians. The virus was, is, among us. Every day we work with a full room ,
next to the disease, "he
says now, a Sunday in June 2021, accepting -one year later- the obvious: the almost inevitable contagion.
Silvia is 50 years old, but through the cell phone screen she appears less.
Her hair is loose and her eyes are outlined behind glasses that occupy half her face.
Her cheekbones are high and her voice is clear through the video call.
At times she lengthens the vowels and then a pronunciation typical of Córdoba capital is perceived, where she and her husband were born.
Silvia Bustos, head of one of the Covid-19 wards of the General Hospital Agudos “Virgen Carmen” in Zárate.
Photo: Lucia Merle
In 1996, Silvia arrived in Buenos Aires.
For 25 years he has worked at the Virgen del Carmen de Zárate General Hospital for Acute Pain.
There, despite being her place of trust, she
did not take her husband to attend.
He did not do it for two reasons: first, he did not occupy a public hospital bed while having a social work;
and second, not to add pressure to your colleagues to treat a family member of a team member.
On the other hand, when she observed that her husband's monitoring could no longer be limited to putting a thermometer on him, measuring the amount of oxygen in his blood and listening to his lungs, she did take him to the Austral Hospital in Pilar.
"I thought 'I can't hold my husband without knowing what else he has'. I called the social work and they asked me if I could bring him to a clinic.' I also have the virus, 'I said, but I ended the conversation with a' leave , I see how I manage. 'I cut off and got my husband into the car and took him to the Austral. At that moment,
a terrible phase
began
for me. "
At the Austral Hospital, Silvia Bustos confused her role: "Now you are a patient and a family member. You are not your husband's doctor," a doctor reminded her.
Photo: DPA
They were separated by the hospital guard and her husband was given oxygen.
For a while they were able to talk through WhatsApp but then he ran out of battery.
What followed was a doctor informing her that her husband had
bilateral
Covid
pneumonia
and should be hospitalized.
The same indication applied to her.
"I had forgotten about my symptoms. My concern was him. I told the doctor that
I could not go to hospital because I had my children alone at home
. He replied that for my health I had to stay. I listened to him and I knew he was right. He was right. to take care of, they had to take care of me. "
For 10 days, Silvia and her husband were hospitalized.
Their children, ages 14 and 16, were isolated in the family home.
From the hospital bed, Silvia made sure that the two teenagers controlled their temperature, ate and, if possible, continued with their routine of virtual classes.
At the same time, he was checking how his eldest daughter was, who lives in Córdoba, where she is studying Biochemistry.
Also from bed and over the phone, he
made prescriptions for his patients at PAMI,
another of his jobs.
He also lied.
"It was horrible: lying to my parents and my mother-in-law. They live in Córdoba and I had to tell them that everything was fine. That my husband had been hospitalized just for control. My mother-in-law wanted to talk to him and I had to find excuses to tell him that not".
It was almost as difficult to call his brother and tell him that he had infected his daughter.
Silvia's niece works as a secretary in the office where she attends to PAMI members.
At some point it infected her too, and in doing so,
she inoculated more guilt.
Guilty of infecting.
Silvia Bustos couldn't help but feel responsible.
Having infected her husband and niece had a great emotional impact on her.
Photo: Lucia Merle
On July 21, 2020 Silvia and her husband were discharged, but for weeks time betrayed her.
Her days passed in the past: she relived the impact of the positive diagnosis, the hospitalization and the effort of her husband to breathe.
He felt bad and there was no relief.
The post-Covid for her was worse than the disease.
"I was very tired, I wanted to sleep all day and at the same time I was insomniac. I was also tachycardic. I cried a lot."
In that state, he had to deal with ART.
In San Martín he had to do the controls: a spirometry and a tomography, among other studies.
Physical exams offered a healthy X-ray but she felt she couldn't work.
"I got tired of traveling to San Martín. I got tired of going so that they gave me three days of leave. 'In three days I will not be well', I told them.
The hospital is my home, I love to work
. I worked with my belly "She makes the gesture of a pregnant belly." I worked sick. I worked with my young children. In 25 years in the hospital I hardly missed and felt that I was begging for days when I was really sick. I got tired and signed the discharge. "
When he returned to the hospital, he did not recognize himself: "Where is that that I am?" He was sad and seeing the patients made him cry. It was an unusual situation. A woman who spent half her life attending in the public system, who runs an inpatient ward, who was trained in internal medicine - a specialty that deals with the diagnosis and treatment of diseases -
could not face patients.
"Silvia, can you help us with the report folders?" Suggested her colleagues, who wanted her reinstatement to be progressive. Later, seeing their sustained anguish, they were direct:
"You have to recover, go home. We can cover you
.
"
On the way home, Silvia remembered a message that had reached her on WhatsApp, through a group from the College of Physicians of the Province of Buenos Aires. The chat mentioned a free and confidential program of Therapeutic Care for Doctors in Crisis (AMEC).
She introduced herself, asked for help and a team of psychologists and psychiatrists, led by Silvia Bentolila, the Argentine psychiatrist with the most experience in
containing victims and in training medical teams and first responders
, listened to her.
At AMEC they gave him 15 days, instead of three, of leave.
"A psychiatric illness
is not seen. It does not appear in an analysis or in a tomography. What I had was
post traumatic stress
, but since it could not be felt or visualized, it was not considered", says Silvia.
During those 15 days of leave, through a very specific activity, and away from medicine, he managed to stop his days from being associated with the guilt of having been an intrafamily vector of Covid.
"Putting together a 15-year-old dress for my daughter took me out of that - by 'that' refers to anguish, ignorance, stress, anxiety, fatigue and fear, and all those mixed emotions. September 2020 I went back to work at the hospital and that same day we celebrated his birthday in the barbecue area at home. We pretended that it was a traditional party of 100 people but there were eight of us. It was a
healing, therapeutic
day
, the beginning of something new. "
Silvia repeats, whenever she can, that now she is able to speak because she has healed.
Before, she says, she couldn't express herself without crying.
But what breaks her after 40 minutes of conversation is the question "How are you today?"
She responds in plural: "And now what we are experiencing is
stress and exhaustion
... It makes me very sad - she interrupts because she is about to cry - Many young people get sick. Many people
die,
" she says already choking. . Every day we are giving bad news. "
Many of his patients are related to each other and have to grieve a father or son or wife or brother amid their own infection.
"Two or three members of the same family die
,
" he
says and recalls that in the last hours he gave a medical report to a woman who was divided between the Zárate hospital and another in Campana.
His son was hospitalized in the first, with assisted respiration.
In the second, her husband, intubated.
"When I see the news and they say that there is a 73% occupancy of beds, 'lie', I say.
Here it is 100%. Warm bed.
One leaves, another enters. The one who enters was on oxygen for two days On a stretcher, cared for, but not on a bed. And if a bed is released it is because another patient died. It is sad. "
Silvia cannot disconnect from the hospital.
He goes over the day's tasks in his head and sends directions over the phone.
She says that the only thing that reassures her is feeling that there was no margin for error in her care, that all the variables were controlled.
"Now I cut you off and ask how the patient in bed 10 is doing
. You don't leave the hospital
anymore and the same thing happens to my colleagues. I'm not the only crazy person," she says and says goodbye.
Cannibal time
Agustina, who is not called Agustina, but asks that her real name not be published, is a
resident doctor
.
Like the rest of the members of the health team, like other residents of the Buenos Aires hospital where she works, she is tired.
Chronically tired.
Since the appearance of the SARS-CoV-2 virus, he has increased his operating room and on-call hours.
"One day I got fed up with a man who demanded to be treated, I said to him: 'Let's do a mathematical account, in how many minutes do you think I can attend to him? To take care of him well, eh, check him, ask him how he is, remove all doubts, ask him all the studies, send him home with a diagnosis or admit him if necessary. What number did he get? Eight, perfect. Make eight times 30, that's the waiting time. Don't kick the door because I'm with another patient. " .
It is the afternoon of a Thursday in June 2021, he has just finished his workday and through a cell phone put on loudspeaker, so that another resident doctor also participates in the talk, he reconstructs the scene, one that is too daily. "It can't be that some people don't understand. I'm not sleeping or drinking mate. I'm working. If this man wants it, I'll take care of him in five minutes. I give him an Ibuprofen and send him home but I
didn't study medicine to be a drug dispenser "
.
When she can and when she finds an interlocutor willing to listen, Agustina explains that limitations in medical care are not always associated with a lack of individual will on the part of her or her colleagues, but rather with an extraordinary demand on physical and human resources. The last time he explained it was four days ago, when a woman had to be operated on urgently. But since there was no bed available for monitoring after surgery,
the procedure was delayed for 24 hours.
"We had asked for the referral six times and it would not come out. That means there was no bed in my hospital and nowhere. Finally a bed was released, we were able to take the woman to the operating room and the patient's daughter was very grateful. She also apologized. because before he had transferred the responsibility for the eventual death of his mother to another doctor. I told him 'but ma'am, it is not that the doctor did not want to operate on your mother. There were not the resources available to do so.' She understood and said Very nice things about what we had done. I don't know if it was because it was late or because of my anguish and accumulated fatigue, but I started to cry in front of the woman. I did not cry with grief although tears fell, something that does not usually happen in front of me to the relative of a patient ".
Of the entire population, medical personnel are the most affected in their mental health, according to a report by PAHO and WHO.
Photo: EFE / Juan Ignacio Roncoroni
How are distance, humanity and efficiency preserved?
How do you handle extreme and sustained pressure?
Facundo, who is not called Facundo but asked to be identified with a fictitious name, is the other resident doctor who participates in the talk and adds: "We doctors handle a great moral burden. We know that we are giving what we can and not what we should. give. We work between two poles:
an idealistic view of medicine and reality.
In the middle, the points do not come close. "
"We don't care not being able to do the most for our patients," Agustina adds. "We try to do our best because we know that with this level of saturation there is nothing more to offer. And what do you do when there is no more. Do you complain about it? with the patient? Do you do nothing? Do you stop the medicine? What do you do? "
Facundo believes that
low wages, moonlighting, and 24- and 48-hour
shifts perpetuate an abusive system with its workers and ineffective with patients.
Sometimes he wonders if an event as critical as the pandemic will produce a break.
"I don't know how it could happen but if I say that nothing is going to change, I feel like I'm failing."
Facundo is 27 years old and Agustina, 35. For a decade they have been training and at the same time they have most of their career ahead of them. Today
no one can contemplate medical practice without doing therapy.
"I
send everyone to the psychologist
because to process so much overload you need help," says Agustina.
For her, danger lives in hospitals in the form of dissociation.
"The person is in Narnia - a fantasy world -. He does not respond. For example, a doctor fills out a medical history as if nothing happened, while 30 people knock down the door demanding that he let them in. Or a doctor does not react to it. a patient who goes into unemployment, "he says.
And he continues:
"The stress is such that some are emotionally disconnected
. It is a defense mechanism to survive. Neither in the faculty nor in the health system we are trained to handle stress."
The weight of life changing
Marcelo Mesquida has more than 30 years in the public health service.
He is a hepatologist and for two decades he worked in intensive care, first at Roffo Hospital and later at Penna Hospital.
Photo: Juano Tesone
The coronavirus pandemic placed Marcelo Mesquida in a place he had left 12 years ago.
In 2008, he decided to leave intensive care and end two decades of service in that care unit.
"I went to therapy," he says, "because I was in absolute
burn out
."
It is a Friday in June 2021 and it has been more than a year since your role as a doctor changed.
"I am a gastroenterologist and I am in charge of the Hepatology area of Penna Hospital. In March 2020 the service was re-functionalized. Several doctors were relocated and due to my previous experience
they referred me to therapy"
The decision did not cause him pleasure but it seemed coherent.
Returning to therapy, he found that the technology was different: measurements that in his time were made by eye or mechanically were now computerized.
At the beginning of the pandemic, he tried to make up for his absence of more than a decade in intensive care with the voracious consumption of videos that taught how to operate modern respirators.
"We had the feeling that a tropical hurricane was coming, a phenomenon that had never occurred in Buenos Aires. We had to prepare, without really knowing how," says Marcelo by video call.
He has gray hair and a pained expression, from having seen many things.
"There were very difficult situations that still cost me. One was the separation of the family -Marcelo lived with his 29-year-old son, whom he had to ask to move-. Another was
knowing us or thinking of us as infectious
. Do you remember when they appeared? the posters stuck in the elevators of the buildings? 'Get out of here', their own neighbors wrote to the health workers ".
Another difficult situation, he says, was the moment when team members began to get infected.
"Before, the illness of colleagues existed, obviously. But it occurred in a spaced manner: one who had a heart attack, another who had to be operated on. With the pandemic,
the news about the death of workers from other hospitals destroyed us
. The feeling it was not knowing who would be next, because there were still no vaccines. In my team there were infections and colleagues with severe pneumonia ".
His parents were terrified that he too would fall ill and wanted to persuade him.
First by directly asking him to resign.
Then, upping the ante: "They offered to support me. I am 59 and thirty-something as a doctor. Their proposal shows how concerned they were about me."
"People are hooked on another story and politics, on other discussions. We think 'what country are they in?'
We feel in another dimension Photo: Juano Tesone
Marcelo Mesquida will not say that it was the loss of contact with his three children and their parents.
He won't say it was the loss of his usual job, the closure of his hepatology office.
He will not say that it was the loss of his creative space: rehearsing with the jazz band he formed with his friends.
He will say that all that combined loss was what caused
another to feel.
"It happened to me and my colleagues. We were locked in
a maze that we could not get out of.
There was nothing ahead but to wake up in the morning and go to the hospital. And thoughts revolved around oxygen measurements and homework. the room, "he says. Today, sometimes, when you think about the variants of Covid, you imagine a sad future. "I begin to feel that we do not get out of this anymore. That life is going to be with the mask on and without leaving. Then I am rational again."
In December one circumstance affected him above all others. It was Christmas and
no relatives of the patients who had survived the Covid had approached the hospital
to greet the team. "It is very difficult for the intensive care patient to be grateful again and what the patient's relatives want the least is to knock on that door again. But it still hurt, it hurt a lot. I did not want that to stay that way and I called the younger members of the team, those who were not intensivists and had put a lot of themselves ..... and ... ... Forgive me, "he says and cries.
What the crying prevents him now from telling is that he said thank you.
He reminded them that they had faced a disease without a cure and had a 40% mortality rate.
"Out of 100 people, 60 are alive thanks to the medical staff. It seemed important to say so. That's why I spoke. Obviously with a different kind of integrity, at that moment I didn't start crying."
As if the conversation occurred inside his head, he remains silent, and after a few seconds he says: "We do not want applause, we got into the fire because it was the right thing to do, but
quickly society thought of something else, looked for another side
".
Before the pandemic, Marcelo Mesquida had a plan: at age 65 he would retire and continue attending his office.
But that plan changed: “When this is over, I don't know how eager I'm going to stay.
My feeling is that of
having burned the last cartridges.
Possibly at 65 I will retire from medicine ”.
Caring for those who care
In 2020, many political and health decisions were validated with one argument: avoid the collapse of the health system.
In 2021 the system collapsed.
Those who work in hospitals, sanitariums and clinics were not only trapped in a repeated scenario, but worse.
Today the list of
ailments, ailments and diseases among health workers
is brutal: gastritis, headaches, irritability, anxiety attacks, insomnia, panic attacks, depression, arrhythmias, skin problems, eating disorders, dizziness , contractures, hyperactivity, anger and self-medication.
"In the pandemic they authorized themselves to feel bad. Before, feeling bad was a trait of weakness," says Silvia Bentolila, psychiatrist, coordinator of the therapeutic assistance program in which Silvia Bustos asked for help (AMEC) and of the Program of Mental Health Care to the doctor (PASMMe). "There is a wrong social and training mandate: 'Health workers have to deal with people who are suffering on a daily basis, but if they feel bad about being exposed to other people's pain they are lazy or lazy." Thus, being human in front of a human being is frowned upon.
Silvia has 30 years of experience in mental health and emergencies.
She worked giving care to victims of the Tartagal avalanche, the Once railway tragedy, the La Plata flood and the Rosario building explosion.
He also gave assistance in the after the veterans of the
Malvinas War
and in the after the relatives and survivors of
Cro
-
Magnon
.
In a country with frequent tragedies, he does not remember a critical event of such a long duration.
Silvia Bentolila is a psychiatrist and health specialist, an expert in emergencies and disasters.
He is a member of the PAHO / WHO Regional Health Emergency Response Team.
"If there is no preventive intervention, the consequences will be profound," warns Silvia on a Saturday in June 2021, by phone from her home.
“When you talk about the fatigue of the health team, you don't understand what it means.
Attrition is not an event, it is a process
, it is not about them needing to sleep, but rather that workers are in a state in which exhaustion and stress end up being conditioning factors for medical error ”.
Stress is an automatic response
.
It is triggered when a person is perceived to be in danger.
It is an unavoidable function.
But the problem appears when that response becomes chronic: the person is left in a state of hyper alertness, waiting for the threat to be repeated.
"The hyperalert is a cat with the hairs standing up and the back arched, that is watching by where the next blow is going to come", exemplifies Silvia.
And he explains that under this condition, involuntary attention goes up and voluntary attention goes down.
In order for a person to be able to concentrate, they need to have voluntary care available.
"Today we have
hyper-alert
workers
, and consequently less concentrated."
Due to their training -malformation-, some members of the medical team find it difficult to recognize what is happening to them: "It doesn't affect me."
"For me, before or now, it's the same."
But for Silvia Bentolila
there is an impact
.
“The dart inevitably comes.
They are part of a community traversed by the pandemic.
They are part of the intervention team.
They have the stress of witnessing, all day and every day, human suffering.
They can be relatives or friends of an infected person.
They can get infected.
The possibility that it does not impact them on mental health is minus four ”.
Silvia identifies that among her patients there are phrases that are repeated.
"I feel useless."
"They die on me."
"I failed him, I had told him that he was going to save himself and he died."
"One of the factors that most affects the wear and tear of health professionals today is the need to feel efficient," says Silvia.
Society places on them an expectation of
efficiency
and, in turn, they have internalized that
demand
.
It is important that they recognize their own omnipotence fantasies.
Nobody can do everything, even giving themselves 100%.
Medical personnel also wait for 'the cure' and get frustrated and stressed when they don't get it ”.
Doctors are a risk group, Silvia insists, using the semantic field that began to repeat itself in the pandemic.
“Globally, they have
twice the rate of depression of the general population
;
three times the anxiety rate and three times the suicide rate ”.
"It is not free to be constantly in the face of death," Silvia adds.
The operational dissociation with which health workers learn to deal with the suffering of the other, without succumbing to anguish, disconnects them from their own suffering and that generates a lot of wear and tear ".
When everything passes, what numbers will remain?
How many - if they have not yet died or resigned - will be left?
If you are a health worker and you think you need help, you can contact the Medical Assistance Program in Crisis (AMEC), +54 9 11 4435-7478 or the Mental Health Care Program for the doctor (PASMMe) , 4599-9275
SC
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