Outside, it’s a break. The children are playing and the vaccine has brought smiles back to the elderly. To believe that the rainbow of the pandemic has indeed arrived. But in the intensive care unit (ICU) of the Jewish General Hospital, hurricane COVID is still breaking out. In the eye of the storm, great dramas and small miracles continue to play out there every day.
Wearing a surgeon’s cap and a protective gown, Ron Wald emerges, looking devastated, from one of the rooms of K-1, where the intensive care of the university hospital is located. Four days ago, her 91-year-old father died in a neighboring room, swept away by COVID. A week earlier, her 84-year-old mother was also swept away, after being infected by the private caregiver caring for her.
This morning, it’s his brother, David *, 48, to walk through the intensive care door. “How can caregivers break the rules to protect the seniors who depend on them? It was preventable death! Spread the word, ”he pleads, his eyes cloudy.
His brother is at this perilous crossroads of the disease where everything can change quickly. The lucky ones escape this slippery slope thanks to high-flow oxygenation, while others descend head first into a deadly waterfall where intubation remains the only escape route.
“For now, it is stable, but since COVID, my definition of ‘stable’ has changed quite a bit,” insists Dr Evan Wong, one of four doctors who are now looking after the 11 COVID patients on the unit.
Taming the unpredictable
After a year of pandemic, COVID continues to mystify doctors and caregivers, even in intensive care. We know better how to avoid intubation in patients, but we do not know why some are wasting away at lightning speed. “It’s still very unpredictable. Is it genetic? Aspects of this disease still escape us, ”insists Dr.r Paul Warshawsky, head of the ICU at the Jewish General Hospital.
This morning, this doctor opens the doors to his silent hive, this war zone where swarms of nurses, respiratory therapists and specialists have been active for 12 months around each COVID patient.
In this surreal lair, where life and death are played out in seconds, the beeps of the heart monitors beat time. Teams undermined like ghostbusters disinfect the corners of each room which becomes free, after the passage of a steam engine, pushed at full speed for 90 minutes.
At the worst of the first wave, the unit, filled to 150% of capacity, received up to 38 patients. “It was madness. It’s better. But please don’t tell anyone! »Relaunches the Dr Warshawsky.
Indeed, even if the numbers have declined, the patients who end up in the ICU are increasingly in bad shape. At the start of the pandemic, 80% of the sick were saved there. Today, only half survive. “Because high flow oxygen saves a lot of patients intensive care, those who end up here are really, really sick. “
Like this patient in room 30, a sturdy 58-year-old, on a ventilator for six weeks already. His chest bulges with each thrust of the ventilator. To avoid irreversible damage to his vocal cords, he underwent a tracheostomy, like most patients with prolonged intubations.
” He is not feeling right. Even though he is no longer in a coma, he is in delirium. Many COVID patients have strokes. Tomorrow, an MRI (magnetic resonance imaging) will tell us if his brain has been affected. We’ll see, ”sighs the D.r Warshawsky.
Prisoners of their glass cages, his patients are bedridden in negative pressure rooms, separated by huge glass walls. In front, nurses constantly monitor their vital signs on large multi-colored screens.
Three have been intubated and “curarized” for more than a month. They are “on hold,” mired in the quicksand of COVID. They were injected with a muscle paralyzer so they could powerfully pump oxygen into their lungs.
Harnessed to an interlacing of pipes and gleaming devices, they float in another space-time, like cosmonauts attached to their capsule by a fragile thread. “Statistically, we know that one in three will die. But you can never know which one. Each patient who finds himself in front of us has a right to 100% of the chances ”, insists the intensivist leader.
Room 31, Virginia Maranon, 70, looks almost resurrected. The native Bolivian is seated, plugged into the cannula that pours oxygen into her lungs. She does not know how she contracted the virus. She no longer went out, not even for her weekly outing to church, she says in Spanish. “If we can prevent him from intubation, his chances will be much better, because staying mobile helps maintain muscle tone,” explains his doctor.
Room 32 houses an unlikely case. That of a 57-year-old fellow who spent a week on a ventilator, before being disintegrated and “mounted” to the K-10, to the COVID unit. But 72 hours later, he had to be urgently reintubated and placed on a ventilator for two weeks, before emerging again. “Surviving two stays on a ventilator is very rare. He’s been breathing alone for two days. But a very long rehabilitation work awaits him ”, explains Dr Evan Wong.
A virus, diseases
In the afternoon, N95 mask screwed to the face and draped with caps and protective gowns, we end the tour of D’s patients in the COVID zone.r Karl Weiss, infectious disease specialist at the university hospital. Some are in very poor condition. “What we see is that COVID is not a respiratory disease, but a systemic disease that can lead to myocarditis [une inflammation du muscle cardiaque] and many other problems, even to healthy people, ”he says.
A reality which has given here a new meaning to collaboration and united the work teams. More than the latest screens and machines, it is the quality of teamwork that increases patient survival rates, insists Dr.r Warshawsky, welcoming like a star Natali Mahdavian, a physiotherapist now revered in this unit.
Respiratory therapists, nurses, all say they have survived the whirlwind of the past year thanks to the unwavering support of their colleagues. When the respiratory therapist Alexa Yaffy intubated the first patient placed on a ventilator in Quebec, her hands were shaking, but her head of unit, Angie Spiropoulos, was on the phone to support her. “We survived all of that because we were together to help each other,” adds Stephanie Petizian, head nurse in intensive care.
After seeing so many patients die, Dr Warshawsky cannot identify his worst memory of the past year, if not that of all those people who could not be saved.
He prefers to remember the survivors, in particular this young patient of 30, infected at the start of the pandemic in a religious ceremony. “She was intubated, had a tracheo, had multiple blood clots. She had to undergo kidney dialysis, lived through complication after complication. She spent three months with us in intensive care. For me, this incredible case embodies both my worst and best experiences during this pandemic. “
Before leaving the unit, we cross the Dr Wong, eyebrow worried. The condition of Ron Wald’s brother looks good, but not that of another patient, who has just entered intensive care.
“He traveled to Dubai two weeks ago. He is receiving 100% oxygen and has just been returned to the prone position. I walk past his room every five minutes. We might have to intubate it, he said nervously. In this case, there is very little time to curarize and put the patient on a ventilator. “
Here, COVID does not relax and we no longer believe in rainbows for a long time. But sometimes, to unlikely little miracles.
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