Due to the loss of lung function, critically ill patients with new coronavirus sometimes need a ventilator to help the lungs function. But the ventilator cannot save everyone.
In this coronavirus outbreak, medical staff around the world will face a difficult moment-when the patient is diagnosed with no possibility of survival, they have to press the button to turn off the ventilator.
For the patient, this means the end of life; and for the medical staff who turn off the ventilator personally, this is not a torture of their own nature.
“Every time I want to turn off the patient’s ventilator, it makes me extremely painful.” Juanita Nitra, head nurse of the ICU at the Royal Liberty Hospital in London, said.
Because of her job responsibilities, she had to shut down the ventilator to support the patient’s life.
“Sometimes I even feel that I am responsible for the death of another person.”
Nurse turning off patient ventilator by hand
Juanita Nitra ↑
Nitra was born in South India and worked for the National Health Service of England for 16 years. Now she is a dedicated nurse in intensive care, leading her team of nurses in the intensive care unit (ICU) of the Royal Liberty Hospital in London to take care of the new crown critical patients.
“One of my jobs is to turn off the ventilator.”
Two weeks ago, Nitra arrived at the office early in the morning and received a notice from the ICU registry asking her to “terminate the treatment of a critically ill patient.”
This patient also happens to be a nurse, working in a community hospital in his 50s. Nitra immediately informed the patient’s daughter that the patient’s condition was to be stopped and that treatment would be stopped. The patient’s daughter expressed understanding.
“I assure her that her mother has no pain and looks peaceful. I also asked her if she had any wishes or religious needs.
There are a total of 8 beds in this ICU, each of which is close together. Around this patient who was about to be turned off the ventilator, were other serious patients in a coma.
Nitra started the process, closed the curtains, turned off the display, and then she put the telephone receiver to the patient’s ear to let the patient’s daughter talk to her.
Due to the epidemic, relatives were unable to enter the ICU to send patients for the last trip. “Her daughter wants to make a video call with her, but unfortunately, the use of mobile phones is prohibited in the ICU.
At this time in the room, there was only the voice of the patient’s daughter on the phone, and the medical staff were silent. At the request of the patient’s family, Nitra used a computer to play a music video.
Then, Nitra turned off the ventilator.
“I sat next to her and held her hand until she left.”
Under the epidemic, you can’t see the “last side”
Five minutes after turning off the ventilator, the patient died.
Nitra said that she saw the flashing light on the monitor and the heart rate monitor showed zero, “becoming a horizontal line on the screen.”
At the end of the phone, the patient’s daughter did not know that her mother had left at this time and was still talking to her on the phone while praying.
Nitra pulled out the sedative tube, picked up the microphone, and told the other party with a heavy heart, “It’s over.”
At this time, Nitra’s task has not been completed yet-with the help of her colleagues, she took a bath of the body, wrapped it with white cloth, and moved it into the body bag. “Before closing the bag, I drew a cross on her forehead.”
“It’s really sad to see a living person die like that alone.”
Nitra said that despite this, she still feels that taking care of the patients who are dying can let them leave in the most peaceful state as possible, which can also comfort her.
“I’ve seen patients die desperately because they desperately want to breathe, and the picture is very depressing.”
Although modern hospitals are developing rapidly and treatments are becoming more and more diverse, turning off life support devices when patients still have signs of life, ethical issues such as hospice care are always difficult for medical staff.
Nitra said that when there is no coronavirus epidemic, whenever this problem is encountered, the doctor will have face-to-face talks with the patient’s family to agree on the final approach.
In the past, when life support equipment was shut down, the closest family members would be allowed to enter the ICU. “However, in the current situation, in most hospitals in the world, this procedure is no longer applicable.”
“The average ICU has one death every day”
Up to now, the number of confirmed cases of new crowns in the UK has reached 150,000, and 20,000 have died.
Due to the violent outbreak of coronavirus, the Royal Free Hospital in London where Nitra is located is in an overloaded state like many hospitals around the world.
The number of beds in the intensive care unit of this hospital increased from 34 to 60, and all of them were occupied. Nitra said that they usually keep nurses and patients one-on-one in the ICU, but now a nurse is responsible for three patients.
“If the situation continues to deteriorate, a nurse will face six patients.”
Nitra’s nurse team ↑
Several of the nurses in Nitra ’s team also developed symptoms of infection and were isolating themselves. The hospital is urgently training other supportive nurses to go to work in the intensive care unit.
“Before each shift starts, we will hold each other’s hands and say be safe.” Nitra said, everyone will take care of each other and make sure everyone wears gloves, masks and protective clothing.
Like most hospitals, the Royal Liberty Hospital in London is in a shortage of supplies. There are shortages of ventilators, infusion pumps, oxygen bottles, and many medicines. Fortunately, there are enough protective clothing for the entire team.
Nitra said that in this ICU, an average of one person will die every day, which is much higher than the number of new corona viruses before the global pandemic.
As head nurse, Nitra must suppress his fears and lead the team to fight day and night.
“In fact, this is scary. I often have nightmares and can’t sleep. I’m also worried that I will be infected with viruses. In fact, everyone is very scared when communicating with colleagues.”
Just last year, Nitra stopped working for several months because of tuberculosis. She said that she knew that her lung function had been damaged, and she would have a higher risk in front of the new coronavirus.
“A lot of people advised me that I shouldn’t work on the front line in this situation. But this is a disaster for all mankind. I have to stand up and do my own duty.”
Nitra said that when she finished her work, she would think of patients who died under her care.
“But I will try my best to let my brain rest when I walk out of the hospital door.”
Nitra (middle) and colleagues ↑
Sad stories like Nitra are happening almost every day now.
During the epidemic, medical staff and ventilator resources are in short supply. With the utmost respect for the wishes of patients and their families, the hospital must end the operation of life support equipment at an appropriate time.
It is necessary to “end” the patient’s life with his own hands. This is undoubtedly a huge psychological pressure for every medical worker who is responsible for saving lives.
Behind all the medical staff who carry forward the burden, the test is also the entire human civilization society, the ethical concept of the end-of-life medical care.
I hope that all of this will end soon.