The face of Simone, a nurse in the emergency room (ED), darkens when she hears what came from her patient’s CT scan. An aneurysm. In other words, his body artery is about to burst. In other words, she has to run.
She takes out her blue backpack. The patient, a middle-aged man, is still under the colossal scanning device. It makes a monotonous buzzing sound, as if a large hair dryer is on. The man’s hands are shaking. Nerves, probably. A person at his most vulnerable. He came in here a few hours ago with complaints, it looked like kidney stones, pretty harmless. Now his family needs to be called.
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Simone squeezes his hand gently. “We are going to help you, you will be operated on soon.” Together with colleagues, she connects the man to the monitor that she takes out of her backpack; a tangle of wires. “That way we can monitor his heart rate, blood pressure and oxygen levels.”
The man has high blood pressure, but when Simone held his hand, she immediately saw it drop briefly. What she means by saying: caring is more than just connecting someone to a monitor. “I want to have time for reassurance, holding hands, that work.”
There is little or no time for that, says Ramona, department head of the A&E department. “In the first wave, only people with covid complaints came here. That was bizarre. It was incredibly quiet in many departments.” Even so calmly, that doctors called out: chest pressure? Go to the hospital. “Many people didn’t dare because of that unknown virus.”
A kind of funnel
But now people know where to find the emergency room again. This place is the funnel of the hospital: here people are helped and sent home, or they go ‘deeper’ into the hospital, to another department.
A number of treatment rooms are located on either side of the emergency room, in the middle of the room are computers, behind them all white coats, busy typing. Monitor beeps together form a rhythmic chorus. In a corner, Sinterklaas is sitting on a chair made of latex gloves, toilet paper and red protective aprons.
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The flow here is fuller than full every day, and not only with covid patients, but also with patients who are now getting sick, or who develop complaints because their care was postponed in the first waves. Like yesterday, a man with a gallbladder infection – he was due to have surgery a year ago. But then there was no room.
“If you wait long enough, they will become urgent on their own,” says Ramona. “And that is where the problem lies for a large part: the combination of covid and additionally much delayed non-covid care.”
To the left or to the right
Doctor’s assistant Esther sees all these people when she works behind the counter in the A&E department. She sends the covid patients and the ‘suspicious cases’ to the left, to the covid unit, and the regular patients to the right, to the ‘clean’ part.
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In the clean area, the doors are covered with reassuring green stickers: ‘covid-free’. But corona is not far away here, corona is one door away, on a protected part that used to be the observatory of the emergency room: the place where patients could normally wait for their transfer results.
Now there are patients who also need a lot of intensive care and for whom a lot of staff is needed. “And the people who work in that covid unit are no longer available for the regular patients with non-corona symptoms.”
No more sitting quietly
Esther tells her story in the staff room, behind her you can take a look at the ‘covid corridor’ through the window. It can be seen how two patients, one minute apart, both wearing an oxygen mask, are driven to the covid unit. “Seeing that, I can’t take a break here quietly.”
“You know how I sometimes feel? We’ve been doing disaster drills in November for years. I feel like we’ve been doing disaster drills every day for 20 months.”
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Head of department Ramona is concerned about the staff. In that very first wave, in addition to fear, she saw a lot of adrenaline in the employees here, motivation, ‘twinkle eyes above those mouth caps’. “Now people are falling out, while this space” – she points around her for a moment – “but continues to fill up.”
Goosebumps from
The darkest doomsday scenario, having to make choices, sending patients away, that gives Ramona ‘goosebumps’. “All over my body.” Will that moment come? She shrugs. “You know. We do everything we can to prevent this from happening. I have seen so many great collaborations between departments over the past two years, and so much flexibility. But now we have to take care of both covid patients and regular patients who are now getting sick. , and the patients whose care has been postponed…”
She pauses, raises her hands. “We’re doing it. I’m proud of that. But sometimes I think: how then?”
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“I like hectic pace and helping people,” says nurse Simone. “That’s why I keep going. And so do my colleagues.” Her patient, the man with the very weak body artery, is now in the emergency room’s shock room. This room is indispensable for serious cases awaiting emergency surgery. X-ray equipment, IVs, heart monitor, blood pressure monitor, a saturation monitor, enough walking space for a whole team. “If things go wrong here, we can do a lot here.”
The hospital has two such shock rooms. One is now invariably reserved for the covid part, where the corona patients come who need to be intubated or resuscitated. “So we have been missing a shock room for regular patients for twenty months. So if a patient like this man comes in now, without covid, with something life-threatening, yes. Then. Yes.”
Than what?
“Then the patient has to be taken to another room or even another hospital.”
To ensure the safety of hospital staff, their surnames have been omitted. They are known to the editors.
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Read more?
This is part one of the four-part story series about stalled care in hospitals. The next episode is about the special corona department within the emergency room.
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