For many patients with acute Covid-19 a timely connection to the apparatus of artificial lung ventilation (ALV) — often a matter of life and death. However, even this device does not guarantee salvation, and doctors worldwide have to make hard choices, turning off the respirator in cases where there is no hope remains, writes the BBC.
“To turn the machine off emotionally is very difficult and very painful. Sometimes it even seems that I am personally responsible for someone’s death,” admits Juanita Nettle.
Juanita was born in southern India, but the last 16 years working in the British national health system (NHS). She is the head nurse in the intensive care unit of the London hospital Royal Free Hospital. 42-year-old Nittle often in situations when doctors have no choice but to stop supporting the patient’s life using itself Appart artificial lung ventilation (ALV).
The last will of the dying
Once in the beginning of April, when Juanita came for the morning shift, head office informed that she would have to terminate treatment of a patient with Covid-19. Patient was also a nurse, a woman aged over 50. Juanita had to explain to her daughter what will be the procedure.
“I tried to assure the girl that her mother isn’t in pain and feels quite comfortable, and asked if the patient has any last wishes, including religious nature”.
In intensive care unit beds are next to each other, and in addition dying patient Nettly there were other patients who were also unconscious.
“She was lying in the box on eight beds, everything — seriously ill. I pulled the curtain and turned off sound notification for devices”.
All the medical staff in the ward froze for a few minutes.
“The nurses were silent, because the dignity and comfort of patients is our first priority,” says Nettle.
Then she raised the phone to his ear and the patient gave daughters the opportunity to say parting words to his mother.
“For me it was just a phone call, but for her family it was of great importance. Of course, they would like to be able to make a video call, but, unfortunately, the ICU banned the use of mobile phones.”
At the request of the relatives of a dying Juanita turned on the computer chosen music video and then turned off the ventilator.
“I sat there and held her hand until she died,” says the nurse.
The decision to stop treatment and disconnected from the instrument was adopted by a group of physicians only after careful evaluation of the patient, his age, medical history, response to treatment and chances of recovery.
In the case of Nettley her client died five minutes after disconnecting the ventilator.
“I saw on the monitor began to blink alarms, and then the electrocardiogram showed a continuous straight line on the screen, the heart stopped beating”.
Then the nurse disconnected the IV drips, supplying to the blood the patient sedatives.
The daughter of the patient, not knowing about what is happening in the house, continued to say something to the mother on the phone and prayers. With a heavy heart Nettle was forced to pick up the phone and tell him it’s over.
However, according to Juanita, the death of the patient her duties do not stop.
“With the help of colleagues I washed it, wrapped in a white shroud and placed the body in a special bag, but first put on her forehead the image of the cross,” explains the nurse.
Also before relatives were allowed to be present in the ICU when disconnecting life-sustaining equipment. However, in connection with the situation in most countries this practice is now abolished.
“It is sad to see people die alone,” says Nettle and recognizes that helping the dying, she can cope better with the situation.
A shortage of beds
Due to the large influx of patients in intensive care unit was expanded from 34 to 60 beds. Now they are all busy.
In the intensive care unit working a whole army of 175 nurses.
“Usually in the intensive care unit a one to one ratio, but now every nurse has three patients. And if the situation will continue to deteriorate, each nurse will have six patients”.
Some of the nurses showed symptoms of the coronavirus, and they are left in isolation. Had to restructure nurses of other specialties to work in intensive care.
“Before each shift we join hands and say like a mantra: “Let everything be well”. We look out for each other, making sure everyone was wearing gloves, masks and other means of protection,” says Nettle.
In the hospital there is a shortage of medical ventilators, infusion pumps (for metered-dose administration to patients of drugs), oxygen tanks and many necessary medicines.
Fortunately, the clinic has enough PPE for all personnel.
In the intensive care unit on average recorded one death a day is much above average in the period before the pandemic.
“It’s very depressing — recognized Nettle — I Have nightmares, I can’t sleep, I think I’m infected, I communicate a lot with colleagues and they are all afraid.”
Last year a few months she was sick with tuberculosis and knows that the possibility of her lungs are severely limited. But she, as a senior nurse, sometimes you have to suppress their own fears.
“I often say that I don’t have to go to work, but now a pandemic, and you have to put everything aside and do your job.”
“At the end of the shift, I always think about the patients who have this day died, but I’m trying to switch to something else when I came out of the walls of the hospital.”
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