Macarena Piñeda was in charge of who would be one of the first fatal victims of covid-19 at the Public Assistance Emergency Hospital, better known as Posta Central, in Santiago de Chile.
The 28-year-old nurse saw her die when there was hardly any information about a strange virus that came from the distant Chinese city of Wuhan.
A year and a half later, he explains to BBC Mundo what it has been like to deal with illness and death in one of the most saturated places with serious covid patients in the South American country.
Despite the fact that much has been said about the characteristics of the virus and the workload of health personnel in the world, there are many unknown details for those who do not work in that environment.
In this article, Macarena Piñeda delivers a crude account of the work she must do on a daily basis to try to save her decompensated patients and, if not, from the exhausting post-mortem task that she contemplates.
What follows is his first-person account.
Deal with death
We were used to having critical patients, but the pandemic turned 180 degrees.
Covid-19 is a very treacherous disease. You never know how patients are going to react and, from one minute to the next, they can get out of balance.
There is no doubt that second hello it has been much worse than the first. I do not know if the patients are arriving late or the bug is being more virulent, more catastrophic, but they are presenting very bad exams.
Normally, I have three patients in charge. Every two hours, I have to change their position. The workload has increased too much.
We don’t even have time to go to the bathroom, to have breakfast or to eat. Only at 5 in the afternoon can I have something to eat. It is that the severity of moving a covid patient is very high and, if you stop looking at him, he may decompose from one second to another.
Suddenly we have four deceased, one after the other, with simultaneous stoppages, intubations … Doctors and nurses have to divide. That is something that did not happen regularly before. Now you have to arrive with a higher energy because if not, you will not have to work 24 hours.
What patients with covid are found (face down), then it is very difficult to treat them. It requires a lot of staff, to have six eyes on the monitor and six eyes on the patient. If he becomes unemployed, you have to turn him over to give him a massage.
We always have to be prepared for the worst.
Although we are more familiar with death, the process that one has to do post mortem in the case of covid-19 it is very chaotic, very sad.
Putting a patient in a mortuary bag is the most shocking thing I have done in my six-year career.
You put it in the bag and that patient doesn’t come out of there anymore. It goes with his name on top of this bag to pathology and from there straight to the coffin. And it is not opened any more, it is sealed, and his relatives did not see his face, ever again.
For me that is terrible. It is very distressing, sad all over.
We have to contain people outside the hospital. They beg you to enter so they can hug their dead relatives. And what else would I give to say yes. But sadly I can’t. The protocol does not allow it. That is the most distressing part of the process.
In the end you are the one who has to mourn the patient, touch him, read him letters or show him audios while his relatives say goodbye through a door.
And there are people who need to say goodbye, who have to go through the process of seeing it; it is part of their grief. I would love to help you, but I can’t.
A close relationship
When a patient is seriously ill, I try not to separate myself from him. Nobody would like to die alone, that’s why I’m not moving from their side.
I give them the hand, I make them love, I like that they feel a presence next to them. I think that maybe I helped them to die more calmly.
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Having a sick person die having given everything is very frustrating. Because in addition, many times that patient was stable for a long time and, suddenly, he decompensated.
Everyone tells you: ‘well, but it’s part of your job’, but nobody knows what it is like to really be inside that room and see when a patient dies after having done everything to save him.
We, the nurses, are the ones who know the patient best; how does he behave, what is really good for him, what is the position in which the patient is decompensated. And you know all that because you spend all day in front of him.
We have a commitment to them; We wash their hair, we heal their injuries. It is a very enriching job.
Sometimes, you see that the patient’s exams get worse and you have to say: ‘hey, you know what, your exams are not going well, we are going to have to intubate you, you are not breathing in the correct way’. And many feel perfect.
At that time, young people are the ones who feel the most fear, perhaps because they feel death more distant.
There are those who write letters, try to record videos or send audio to relatives … because it is so complicated to promise that patient that he will wake up again, that they prefer to start saying goodbye.
This virus is so treacherous, you don’t know anything. Not even we have that certainty.
After a long sedation, there are some patients who find it more difficult to return. Usually to patients of covid-19 they must be intubated so that the air reaches their lungs, which does the process to wake them up Even harder.
Certain people may even experience the delirium disorder, a state of mental alteration that generates confusion and restlessness.
Patients with delirium sThey feel that the whole world is against them.
They bite the tube, they try to take it out, it’s complicated. They are super aggressive and many times we have to try to calm them down among several. Because containing a patient who measures 1.80 centimeters and weighs 100 kilos is not easy.
We say to him: ‘Look, sir, you are hospitalized, we are waking you up, calm down, we want to remove this tube from your mouth, we know your throat hurts. But if it continues like this, we’re going to have to sedate again and back off. ‘
But uA delirious patient does not listen to you much. Unfortunately, many times you have to go to the pharmacological because they cannot understand. And there the medications help to have a calmer awakening.
A lonely fight
I’m tired. We are all tired. I no longer see or read news.
Because every day is the same: that the cases have increased, that the worst is coming. And I’m living it, so why am I going to keep watching the news? I’d rather not, for sanity.
I don’t understand the people who organize Clandestine parties or they skip the curfew.
To those people, I say: maybe you want to get together with your friends, but I have seen families hospitalized, mothers losing their children. They believe that it will not happen to them but it happens, and it happens a lot. There are young people who kill their grandparents, they kill their parents just because they want to spend time with their friends.
Many believe that this is a game, but I would love to invite you one day to see how the disease behaves so that they have a little more respect for him.
Covid-19 has highlighted inequality, both in the health system and in people’s daily lives. We know that the humblest, the poorest people, are the ones who are losing the battle in this pandemic.
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The rich get richer and the poor get poorer. And I know that there are people who need to work and go out. So I understand them. What I don’t understand is skipping the curfew, having clandestine parties.
I think there are some super unaware. And it is minimal effort; if not, we will never be able to get out of this pandemic.
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