Coronavirus: a day in ground zero

The pager rings at 8:30 am, who is calling? She is from UCQ, a surgical care unit, although it has been converted into an ICU (intensive care unit) to house patients with coronavirus infection requiring respiratory assistance. They want us to perform a tracheostomy on one of the patients intubated due to the virus, which has been hospitalized with assisted ventilation for a long time.

Under normal conditions, the patient would be transferred to an operating room to undergo the procedure and, if unable, a percutaneous tracheostomy could be performed in the same ICU bed, but we are in the perfect storm. Given the circumstances of the epidemic, it is advisable to reduce the movements of infected patients to a minimum Furthermore, this patient is obese, which is one of the risk factors for serious COVID infections and that prevents the minimally invasive technique from being performed.

The hospital has had to be restructured. A macro unit has been created for patients affected by the virus in which infectious disease doctors, internal medicine, pulmonology, etc. work. As these health personnel are dedicated to COVID, patients with different diseases, normal in a hospital, they are being treated by other doctors, even if they are not of the corresponding specialty. We have had two patients with heart failure and a cerebral hematoma, which by the way, are currently evolving satisfactorily.

Scarce material

Furthermore, the feeling is strange. The hospital is emptier than normal. By limiting family visits there are fewer people, but the feeling is misleading, ICUs are almost full and entire plants have been dedicated to those affected by the virus. Material is scarce and, due to theft of masks and gowns during the previous weeks, these are locked and must be requested from the respective nursing supervisors when needed.

The solution for tracheostomy is setting up an impromptu operating room in the patient's bed at UCQ. Surgical instruments, cannulas, gauze, compresses, etc. And of course, the staff. To do This technique requires two surgeons and an instrumentalist nurse. Logically, precautionary measures make it prudent to minimize the personnel that circulate in the area.

It is not for less. Driving through the UCQ hallway gives respect even to doctors with nearly 30 years of experience like me. Most of the patients, practically all of them, are intubated and placed upside down –something that is rarely done under normal circumstances– to facilitate oxygenation of the body.

Preparation is not an easy thing. It begins with the placement of the cap and two masks, the one below, normal and above a FFP2, more secure. Then the tights, regular hand washing, donning the waterproof gown and gloves, two pairs, one on top of the other. The scrub nurse looks worried. She is almost newly hired and she has had it. Protective suits like the ones we see in China on TV or in movies are not available in the hospital.

Respect yes fear no

You may wonder if doctors are afraid in these circumstances. Yesterday there were 180 doctors from the discharge hospital and one admitted to the ICU, diagnosed with COVID or with suspicion, not to mention the rest of the personnel for whom I do not know the data. I can not speak for my colleagues but I have concern for my family and friends, but not fear.

Personally I have already experienced more epidemics such as multi-drug resistant tuberculosis, in 1997, that caused the death of doctors and nurses and I have operated on patients with the ability to transmit hepatitis or HIV. It is something that most of us have done. It is also our job and our moral duty. Every day in any hospital people die but they don't appear in the media. Thank you very much to all the citizens who applaud your windows and thank us daily.

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