Inside intensive care unit fighting Covid-19. ‘You don’t know how to help them'

Benas Gerdžiūnas, Justinas Stacevičius, LRT.lt
2020.11.23 08:00
An elderly man arrives from Utena, northeastern Lithuania. Before, patients would be transferred to the main hospital in Vilnius, the Lithuanian capital. But now, it has also been overwhelmed with new patients.

Although chaos and fear of the unknown have subsided, the second wave of the coronavirus pandemic has swept over Lithuania. Praised internationally for stellar performance last spring, the country is now seeing its hospitals beginning to fill up.

A wheezing sound follows the airflow. Once it ceases, a tremble reverberates across the patient’s body as his lungs receive another gasp of oxygen. His chest quickly falls again, and the wheezing sound resumes.

Out of the seven beds available for Covid-19 patients at Panevėžys Republic Hospital in northern Lithuania, four are occupied. Many patients end up needing lung ventilators, the last resort in the fight against the novel coronavirus.

It’s 50-50 from then on, says Daumantė, a nurse at the intensive care unit of the hospital. Just days before the second nationwide quarantine came into effect in Lithuania on November 7, the ICUs began filling up.

“There is no cure,” says doctor Ričardas. “Patients come in, you feel sorry for them, but you don’t know how to help them.” Remedies such as hormonal treatment can help alleviate symptoms, but there is no silver bullet, he adds.

A patient placed on a ventilator.
A patient placed on a ventilator. / J. Stacevičius/LRT
A window panel separates the quarantine ward – where the patients are still awaiting their Covid-19 test results – from the room housing coronavirus patients. If there’s an influx of patients, the panel can be opened up to expand the Covid ward.
A window panel separates the quarantine ward – where the patients are still awaiting their Covid-19 test results – from the room housing coronavirus patients. If there’s an influx of patients, the panel can be opened up to expand the Covid ward. / J. Stacevičius/LRT
While some medics in hazmat suits stand at the ‘post’ – their work station in front of the patients – others waiting to be rotated in can still monitor the patients’ vitals from inside their room.
While some medics in hazmat suits stand at the ‘post’ – their work station in front of the patients – others waiting to be rotated in can still monitor the patients’ vitals from inside their room. / J. Stacevičius/LRT

During yet another 24-hour shift, doctors get a call to transfer one of the four patients out of the Covid-19 ward. His tests came back negative, meaning that after spending 25 days in the ICU, he is free of coronavirus and can be transferred to a non-infected ward.

We follow two medics into a dressing room where they prepare to enter the Covid ward. The procedure is meticulous.

Dressed down to their underwear, the medics put on fabric overalls, followed by socks. Then, plastic overshoes, overalls, gloves, a mask, a hat, a second hat, gloves, a second pair of gloves, a hoodie, all fastened into place with additional tape.

Daumantė, a nurse, prepares for entry into the Covid ward.
Daumantė, a nurse, prepares for entry into the Covid ward. / J. Stacevičius/LRT
The medics cut holes for thumbs in the plastic overalls and apply sticky tape to keep everything in place.
The medics cut holes for thumbs in the plastic overalls and apply sticky tape to keep everything in place. / B. Gerdžiūnas/LRT
At first, it was really difficult mentally, according to Naumantė. After hours inside the hazmat suit, the body loses a lot of liquids and balances on the brink of exhaustion, she adds.
At first, it was really difficult mentally, according to Naumantė. After hours inside the hazmat suit, the body loses a lot of liquids and balances on the brink of exhaustion, she adds. / J. Stacevičius/LRT
Medics peer inside the ward. They are wearing additional aprons, which are needed for extra protection when handling Covid-19 patients.
Medics peer inside the ward. They are wearing additional aprons, which are needed for extra protection when handling Covid-19 patients. / J. Stacevičius/LRT

The procedure takes several careful minutes. The whole multi-layered protection will go into the bin after leaving the Covid zone, followed by a careful shower. After the medics take a break between their four-hour shifts inside the ward, the cycle repeats.

"My record is seven hours” inside the hazmat suit, says nurse Daumantė.

The protocol took some learning. “At first we didn’t know what to do,” she remembers. In mid-March, when the hospital was still finalising guidelines on how to use the protective equipment and work around coronavirus infections, “we received the first patient”.

Lithuania went into the first quarantine and the medics faced the unknown. During the first days, “we trembled when putting on the protective measures”, says Daumantė. “We used to call the Covid zone ‘the reactor’.”

At the Covid ward, another nurse checks on patients once the screen monitoring their blood and oxygen levels starts beeping. Her glasses are fogged up from hours of work.

The glasses worn by a medic are almost completely fogged up from the hours of work.
The glasses worn by a medic are almost completely fogged up from the hours of work. / J. Stacevičius/LRT

“Are you sure you’re alright?” she calls out after a patient’s device raises alarm. “Yes, yes, I’m fine,” the elderly man replies, his breathing supported by an oxygen mask. He has double pneumonia, one of the most common and deadliest complications of Covid-19.

Meanwhile, the coronavirus-free patient hooked onto a lung ventilator is wheeled into an interim zone. Hunched over, medics wash and transfer the comatose body to a ‘clean’ bed.

“When we say a person is cured from Covid, it only means that they are no longer able to infect others,” says Ričardas. The complications, including pneumonia, persist.

A patient who has now tested negative for Covid-19 is being transferred into a non-infected ward.
A patient who has now tested negative for Covid-19 is being transferred into a non-infected ward. / J. Stacevičius/LRT
He is washed and put into a ‘clean’ bed while still hooked on a portable lung ventilator.
He is washed and put into a ‘clean’ bed while still hooked on a portable lung ventilator. / B. Gerdžiūnas/LRT

But some are able to recover even after being placed on a lung ventilator. A woman in her 40s, another doctor remembers, spent a week in an induced coma while hooked on the machine. She eventually recovered and was released in due time.

Spike of new infections

Lithuania along with the other Baltic states made headlines last spring for successfully suppressing the pandemic. Countries elsewhere in Central and Eastern Europe were also among the least-hit.

But the second wave reversed the trend. The bar graph of dozens of daily new infections during Lithuania’s first wave disappears when scaled against the thousands of cases since late October. Most of Lithuania’s neighbours have fared no better.

“We have a delayed reaction of about two weeks,” says Ričardas, explaining that hundreds of patients start flooding infectious disease departments about 14 days after a spike. Another two weeks later, dozens of patients whose health deteriorates end up in intensive care wards.

A medic checks up on one of the Covid-19 patients.
A medic checks up on one of the Covid-19 patients. / J. Stacevičius/LRT
Medics prepare the new patient who arrived from Utena for hospitalisation.
Medics prepare the new patient who arrived from Utena for hospitalisation. / J. Stacevičius/LRT
Meanwhile, the man reaches for a glass of water after the 100-kilometre journey from Utena.
Meanwhile, the man reaches for a glass of water after the 100-kilometre journey from Utena. / J. Stacevičius/LRT

Ričardas was one of the three doctors at the department awarded medals by the country’s Health Ministry for their fight during the first wave of the Covid-19 pandemic. But they all turned down the award.

“We thanked them, but refused,” he says. In September, when the ministry handed out the awards, the number of hospitalisations was already rising. “We said that the second wave was due to come,” says Ričardas, and it wasn’t the time to celebrate.

Representatives of hospitals across the country have also pointed at the October parliamentary elections as one of the reasons for the delay in introducing the second quarantine.

Meanwhile, “we are still waiting for the effect of All Souls’ Day to pass us”, he adds. The three-day weekend in late October, when people across the country were visiting graves of their relatives, has been identified by epidemiologists as one of the reasons behind the spike of infections.

A few weeks ago, the intensive care unit at the Panvėžys hospital had one spot remaining. With walls knocked down and extra wards prepped for an influx of patients, doctors were bracing for the worst.

But since the introduction of the second quarantine, the situation has stabilised. “We can work at this pace,” says Ričardas.

People in the society ended up realising that they can also die, says Ričardas.
People in the society ended up realising that they can also die, says Ričardas. / J. Stacevičius/LRT
The medics spend four or more hours at their post.
The medics spend four or more hours at their post. / J. Stacevičius/LRT
 In a ward that houses quarantined patients, who are awaiting their Covid-19 test results, a man drifts between sleep and consciousness. A nurse pauses next to his bed. With the blood pressure spiking, they consult medics about what drugs to administer.
In a ward that houses quarantined patients, who are awaiting their Covid-19 test results, a man drifts between sleep and consciousness. A nurse pauses next to his bed. With the blood pressure spiking, they consult medics about what drugs to administer. / J. Stacevičius/LRT

Hospitals have all the necessary equipment to treat more patients, but the problem lies in human resources – “there is simply no pool of available workers able to step in,” says Ričardas.

Placing more beds in corridors is not an issue, but that will do little when there are no medics to monitor patients during the weeks-long hospitalisations required by each.

“You can keep one person [alive] for a long time,” says Ričardas. “But when there are 20 lining up outside the door – like how it was in Italy – then you need to start making decisions.”

She later passes the pills and the man drifts back to sleep – without a cure, the medics only address the symptoms.
She later passes the pills and the man drifts back to sleep – without a cure, the medics only address the symptoms. / J. Stacevičius/LRT
An elderly woman is still hooked on a lung ventilator. Although now free of Covid-19, she has developed pneumonia.
An elderly woman is still hooked on a lung ventilator. Although now free of Covid-19, she has developed pneumonia. / B. Gerdžiūnas/LRT
A man falls back asleep after drinking his medication. Outside, a boy leaves a school located next to the hospital.
A man falls back asleep after drinking his medication. Outside, a boy leaves a school located next to the hospital. / B. Gerdžiūnas/LRT
If a patient succumbs to the disease, or is moved to a different ward, the entire space is washed down and prepared for the next patient.
If a patient succumbs to the disease, or is moved to a different ward, the entire space is washed down and prepared for the next patient. / B. Gerdžiūnas/LRT

Patients in ICU wards require near-constant attention. The more people are hospitalised, the less attention each will receive. And the more will die.

As of November 20, the death toll from Covid-19 stood at 357, compared to just 87 two months ago on September 20.

Xanax and stigma

During his break, Darius stretches out on a chair, red imprints visible on his face after spending four hours in a hazmat suit.

“Before, it used to be an unpleasant procedure to inform the relatives,” he says. “Now, you do it like a robot.”

Working in an intensive care unit, medics are used to dealing with death. Yet, they are also prone to burnouts and succumbing to psychological pressure.

“The deaths that you end remembering are the ones where you ask yourself if you could have done more,” says Darius. But with Covid patients, there is not much else medics can do but help suppress the symptoms.

“Tension can be felt among the colleagues,” says Ričardas. The worst thing is the continuing unknown about what will happen next, he adds.

The biggest reward is when they are able to save a patient. “That’s the drug that we all live for,” says Ričardas.

But some had to resort to other means to cope.

“Colleagues who can’t write prescriptions,” like nurses and other staff, “have often asked for drugs” such as Xanax and other tranquilisers, according to Darius.

Going to a psychologist is not an option. “If a colleague goes to a psychiatrist, they denounce themselves”, risking a dent in their medical careers, he says.

Darius, a doctor, takes a break. “More people will be affected [by the pandemic] due to this whole tension [and could turn to] alcohol,” he says.
Darius, a doctor, takes a break. “More people will be affected [by the pandemic] due to this whole tension [and could turn to] alcohol,” he says. / J. Stacevičius/LRT
Most patients require oxygen masks.
Most patients require oxygen masks. / J. Stacevičius/LRT

In Panevėžys, with a population of some 85,000 people, everyone knows each other, says Darius. The medical community is especially tight-knit and mental health issues are still stigmatised.

‘We will manage’

A phone in the ward rings at least a few times an hour. This time, it’s a relative asking about a patient’s condition.

“He has double pneumonia, the condition is serious,” Darius says after picking up the receiver. “We are doing everything we can.”

After a few seconds, he concedes. “I don’t know, yes, maybe his condition is somewhat better. We’ll arrange [a call] so he can speak.”

Putting down the phone, he stands in front of four screens in the doctors’ room that monitor patients’ vitals. “Not good,” says Darius. The patient’s oxygen levels are way too low, “but there’s no need for a lung ventilator yet”.

Some, however, have to be placed on lung ventilators.
Some, however, have to be placed on lung ventilators. / J. Stacevičius/LRT
The latter option requires the person to be placed in an induced coma.
The latter option requires the person to be placed in an induced coma. / J. Stacevičius/LRT
With the night falling, the medics turn down the lights in an effort to help stimulate the body’s natural rhythm.
With the night falling, the medics turn down the lights in an effort to help stimulate the body’s natural rhythm. / J. Stacevičius/LRT

His break is interrupted by a call from the operating room. A coronavirus-infected person needs to be transferred into the Covid ward.

Darius jumps up, followed by Daumantė. With still more than half of their 24-hour shift remaining, they squeeze into the hazmat suits for the second time.

Despite the constant stress, the medics are optimistic. “This virus is not Ebola, not the plague, or the Spanish Flu,” says Darius, adding that if the death rate were 100 percent, everything would be different.

“It was scary in the beginning, but now we can manage,” he adds. “We just need a strategy.”

A plastic gateway separating the Covid ward from the quarantine ward. If the number of hospitalisations spike, the screen will be removed to admit more Covid-19 patients.
A plastic gateway separating the Covid ward from the quarantine ward. If the number of hospitalisations spike, the screen will be removed to admit more Covid-19 patients. / B. Gerdžiūnas/LRT
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