Why does time never stop?
Corona crisis in the intensive care units: Listen to us!
Almost 5,000 people are being treated in intensive care units across Germany for Corona. Doctors, nurses and auxiliary staff work every day to save their lives, to look after them and to care for them. For Labor Day, we collected 50 voices from intensive care units - in logs and voice messages.
"I see the tired eyes of my colleagues, of the nursing staff. They are tired and exhausted. Many also feel sadness, because the patients who are now in the intensive care unit are between 30 and 65 years old and are in the middle of it We now almost exclusively have younger patients. Suddenly there are children of all ages standing at the hospital beds and saying goodbye. And we doctors know that young people die there and would still be alive without this infection.
Once I came back to the ward after the weekend and a room was empty. The patient died at the age of 31. Tears flow from time to time, also from the doctors. Because it's hard to take. When it comes to intensive treatment for Covid-19, you ultimately don't have very many causal therapies. You optimize ventilation and care. And waits to see whether the course changes in the right direction. It's like roulette. Sometimes it's fine, sometimes not.
In contrast, with sepsis there is a germ that we can fight with antibiotics. If we have a pulmonary embolism, we can dissolve the clot. In the event of a heart attack, we can open the coronary arteries. With many patients in an intensive care unit, we can do something to bring them back to life. But with Covid-19, when the lungs close, it can hardly be stopped. It has to stop on its own.
I've seen a lot in my professional life; it affects me less emotionally than the younger doctors. And I have techniques on how to deal with this situation. That's why I'm involved in research or in the NoCovid initiative. Because I just couldn't watch how we deal with this pandemic in Germany. And how indecisive politicians act. I can't stand sentences like: "The intensive care units are not really full yet". What image of man is being propagated there? If someone sees a patient lying here and has just a little compassion, then one thing is clear: everyone is one too many. We can't pretend it's normal to let people die from preventable diseases.
There are districts in Cologne that have an incidence of zero. And others that have an incidence of over 500. These are parts of the city where the pandemic is really raging, where people are cramped or have jobs where they cannot protect themselves as well. They are now running into the open knife. Many who claim freedom for themselves usually have far better means of protecting themselves from Covid-19.
Much of the debate is based on a sham discussion that hides the failure by constructing supposed opposites. It was never about weighing freedom or economy against health. Fighting a pandemic averts damage in all areas. We should have made that clear. Maybe we’ll finally start now. "
Ten moments that will never be forgotten
"I've been a nurse in an intensive care unit for eleven years and I've never experienced anything like this before. The situation has been tense - since the end of October last year. All the time, without any improvement, without any breathing difficulties.
In the past year, as many patients died from me as in my eleven years of work combined. I would rip out my arms and legs to do anything for the sick. But I can't grow back so many limbs.
I still remember a patient my mother's age: she had to wear the ventilation mask and was supplied with oxygen by a machine. She was only able to take off the mask and have a drink for a short time. At that moment she grabbed my hand and said that she didn't want to die. I replied: "It will be all right". But I had to lie because I had no idea what would become of her. She died.
I don't want to have to experience that anymore! We should pull ourselves together, even if we are not afraid of the contagion ourselves. Even without symptoms you can infect other people who then end up with us and have to be held by me because their relatives cannot be there. We have to prevent every single such case! "
"After 14 months of the pandemic, everyone in our team is exhausted - nurses, doctors, cleaning staff and so on. Although we have had fewer patients to care for for the first time in two days and two free beds because some have died, the burden is enormous. Often the beds are quickly occupied by new seriously ill patients - not a day on which someone we fought for does not die, and not a day on which we do not fall completely flat in bed in the evening.
But it is above all the psychological stress that hits us. It feels like almost every second person dies at the moment, there is nothing we can do and that is frustrating. And even if a patient is doing better, he or she is often transferred to other clinics - then we rarely find out what actually became of him or her.
Instead, we see suffering, see several middle-aged people die, even one who was just 28 years old. The moments before that are depressing when you talk to your loved ones on the phone again before the artificial coma or face-to-face and say goodbye - knowing that you might be talking to them for the last time. To hear and see that is not easy for us to process either.
Fortunately, we can talk to our colleagues about these experiences and talk to psychologists twice a week after our handover. This helps. Only now I notice more and more that something fundamental has to change, also in the structures of how a health system works. I very much hope that this will change in perspective when the pandemic is over. "
Ten stories of working to the limit
"Today there was another rush to our intensive care units. We have never had so many patients as we have at the moment in the third wave. The situation in our region is generally critical due to the high incidence.
In the past few weeks we have taken on some patients from other hospitals, as all capacities there were exhausted, in one case a patient from another district for ECMO therapy who previously could not be taken over by 18 other hospitals. But now we are also at the limit.
It is therefore a good thing that there is now a federal law linking binding measures to the incidences. This is the only way we can change the situation. Because it doesn't work like this in the long run. We cancel operations, postpone treatments, deploy non-specialist staff in the intensive care units. All of this inevitably means that at some point the quality of care will decline - both for patients with Covid - as well as for patients without Covid. In the interest of everyone, the following applies: We have to keep reducing the number of infections. "
"Every morning I report our occupancy numbers to the Divi bed register - and they are consistently high. We have set up three complete intensive care units at our clinic for Covid-19, reserved 36 intensive care beds for this disease alone. There is no other way. And you have to acknowledge: We in Hamburg are still in a good position; we currently have the lowest incidence of all major cities in Germany.
The situation is very different from region to region, in Schleswig-Holstein the numbers are low, as there are very few intensive care patients with Covid-19. Most of them are in Thuringia, so many clinics are overburdened. We also get inquiries from Lower Saxony every day because the situation there is also very tense. We then also take on the difficult cases. Even within the city of Hamburg, the situation can differ. We only took someone in yesterday because the other hospital couldn't find a free bed for the patient. We are coordinating well and hope that the new federal rules will now take effect everywhere, the numbers will continue to fall and the situation will ease.
And that is urgently needed, because we must not forget: Every third corona patient in the intensive care unit dies! In many cases we cannot save people. It annoys me when people don't want to understand that and still deny Corona, even demonstrate against it. I understand every artist and restaurant operator who is frustrated. The only thing I don't understand is the lateral thinkers. It could hit any of them at any time! "
"Fortunately, we have never been fully booked. We have currently reserved ten beds for Corona patients in our Corona ward, but there have never been more than eight Corona sufferers. We are still in a waiting position and of course we hope that big rush won't come anymore.
What has changed for our patients: They are getting younger and younger. At the beginning of the pandemic, we really only had senior citizens on the ward, now younger people are also joining us. Although you have to say: Everyone under 60 is young for us. Younger patients are now also affected by severe courses. They usually have no previous illnesses. Many are ventilated by ECMO devices.
The pandemic has made my job more exhausting, but I still enjoy it. The mask and protective suit can be annoying, but I've got used to it. But there are also things that really relieve us. I am thinking these days of the modern so-called residual rotor beds, in which we corona patients can buckle up, securely inserted in pillows, they are then automatically rotated: Here the patients are rotated to the right and left, this works up to an angle of 60 Degree. We continue to assume the prone and supine positions, but the technology helps a lot. This is an enormous relief for us nurses and should also be more common on other wards in Germany. "
Ten voices of bewilderment
"What worries me is a special feature that has never been seen before: All patients on our ward have the same thing, all have Covid-19 - they are therefore much less able to differentiate themselves from the fate of their fellow patients if their bed neighbor is intubated or dies, and they know exactly: I have the same thing as him, that can happen to me too.
It's like a gloomy look into possibly your own future, an extreme stress that can be traumatic. The fear of having to be sedated and ventilated oneself and ultimately dying is always there. And this threat lasts for many days. And it is precisely in this highly stressful phase that patients cannot even see their closest relatives because of the ban on visits.
I often get the impression that hardly anyone thinks about the extent of the psychological consequences, even if the patients survive. We know that even in normal times, up to 30 percent of patients after the intensive care unit suffer from symptoms of depression or post-traumatic stress disorder. I would like that this suffering of the survivors is also seen and that there are more offers of support so that they can continue to live well. "
"Just looking at the bed capacity is a big mistake. It is fatal to believe that we can get through this crisis well by providing enough beds. After all, what are beds if there is not enough staff to help them?" At the moment we are doing everything we can to avoid having to talk about triage.
We're postponing operations, canceling treatments, and relocating staff. More and more anesthesia nurses are now working on a corona ward, and dermatologists and other professional groups are also helping out as best they can. In our house, we have long been treating patients in a container clinic, which fortunately has been there since a renovation. This means we have enough capacity, but of course the staff that we drop off from other stations is not there.
Fortunately, many of our employees are vaccinated, so that we have fewer absences and, at least for many, there is no fear of infection. But the hard work has remained, we can only be relieved if fewer patients come to us and people understand that they have to reduce their contacts! "
"The situation is very tense. I'm not talking about a collapse yet, but I see more and more, but especially younger and younger, patients entering our intensive care units. Even people who are only in their early 30s are hit. With us There are also people without significant previous illnesses, who then have severe courses. We recently had a young patient who had breakfast in peace in the morning, and at noon we had to ventilate him.
How do you explain such a development to the relatives? In critical situations we can find ways to enable visits despite the ban on visits, but often we only have the phone. Sometimes we have to convey sad messages. That hurts us too, because we build a relationship with the patients. Especially if, like many younger people, they stay with us for a long time. This is an enormous psychological burden for all of us. Everyone who dies is one too many, but everyone who is still young and has small children hurts in a special way.
We fight for each individual, but with Covid-19 we lose this fight more often than with other diseases. As a university hospital, we also accept many severe cases from all over the area. Either because the clinics in the region cannot carry out complex treatments or because they no longer have enough free beds themselves. We can still step in because we are a bit far from the sad peak of the sick at the beginning of the year. But that is exactly where we are threatening to steer. We are not yet feeling any effect of the new measures and warnings. But I am optimistic that compliance with the federal brake will have an impact and that the situation will improve! "
Ten demands on politics
"The situation in our intensive care units is very tense. And when we look at the number of infections, we suspect: There is still something to come. Every day we expect that there will be even more patients. It is like the last few kilometers a marathon when you can’t do it anymore and think: Really now, it’s still going? Only in the pandemic you cannot even be sure when it’s really over.
I think many cannot imagine how difficult the situation actually is, including for the patients' families. Visits to the ward are only possible in individual cases, and because many relatives are infected themselves, they are not allowed to come anyway. We often try to establish a connection via video over the phone. But this is not a substitute. Because we cannot comfort the relatives when they see their loved one lying there for the first time, unconscious, with a breathing tube in their throat. Normally we would hug the relatives in such a situation.
The touch is perhaps what is missing the most. Many people feel that way, but the patients and their relatives in particular need them so badly. It hurts to see that there is so little we can do to replace this. I hope that the number of infections will finally drop - so that people can touch again. "
Planning: David Gutensohn
Photography: Sebastian Lock, Paula Markert, Marcus Simaitis, Thomas Victor
Photo editing: Dorothea Fiedler, Andreas Prost
Audio: Jannis Carmesin
Final address: Luisa Jacobs, Anne Schade, Hannah Scherkamp
Visualization and programming: Julian Stahnke,Julius Tröger
Social media: Mona Wetzel
We thank the Intensive Public Address Initiative for some voice messages and all those involved for their time: Helios Clinic Berlin-Buch, University Clinic Dresden, Clinic Nuremberg, Emergency Doctor Exchange, University Clinic Mannheim, St. Josefs Hospital Wiesbaden, University Clinic Jena, Helios Clinic Emil von Behring Berlin, University Clinic Cologne , SLK-Kliniken Heilbronn, Universitätsklinikum Essen, Klinikum Stuttgart, Klinikum Magdeburg, Klinik rechts der Isar in Munich, Klinikum Braunschweig, Klinikum Fürth, MHH Hannover, Klinikum Darmstadt, Universitätsklinikum Hamburg and Charité Berlin.
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