On the edge: ICU night shift at a Covid-19 hospital

And they do this day after day while longing for the lockdown on the hospital, a premier Covid-19 treatment facility, to be lifted.

A week ago, on the night of May 13, two patients were admitted to the hospital, one of them in a critical condition. The ICU medical team swung into action immediately, focusing all their attention and energy on trying to save the patient's life.

Le Thi Hong Nhung, a 27-year-old nurse, still remembers the exact moment when she and her colleagues picked up the patients, screaming out loud "Quick, quick! New patients!," even as they picked up the necessary equipment and tools.

The Intensive Care Units (ICU) of all hospitals specialize in the treatment of critically ill patients; but at the National Hospital for Tropical Diseases, which has been designated a Covid-19 specialty hospital, things have acquired a sharper edge after it was placed under a lockdown following the detection of a few cases on its premises.

Worse still, even though the weather in the northern region is very humid at this time, air conditioners are shut down as a Covid-19 precaution. Only a few fans operate at full capacity in the ICU room, not enough to dispel the heat. Very soon, Nhung was drenched in sweat under her protective gear.

"The night was very long and very tiring. I was thirsty and longed for a cold water bottle," Nhung said.

Le Thi Hong Nhung poses for a photo before entering her night shift at the National Hospital for Tropical Diseases, Hanoi, on May 13, 2021. Photo courtesy of Nhung.

Le Thi Hong Nhung poses for a photo before beginning her night shift at the National Hospital for Tropical Diseases, Hanoi, on May 13, 2021. Photo courtesy of Nhung.

But she had no choice but to endure the heat and could not go out to get a drink of water. Critically ill patients need to be closely monitored to prevent complications and might need intervention at any time. She did not dare to neglect or leave her position even for a few minutes, so she chose to ignore her thirst. Her colleagues make similar choices often, too.

The medics work from 7:30 p.m. to 7:30 a.m. handling different tasks including taking care of the patients’ body hygiene, oral hygiene, feeding, changing diapers and giving them medicine.

When Nhung wrapped up her shift, she was exhausted. She removed the protective gear according to the correct protocol, took a shower, drank water and tried to get some rest.

"I didn't think about eating anymore because I was too tired, as was everyone on duty," she said.

Nhung said the number of patients in the ICU during the lockdown period is about the same as at normal times, but Covid-19 patients cannot have family members take care of them, so the task of comprehensive care for patients is taken care of by nurses, greatly increasing their workload.

Pham Van Phuc, 31, a doctor working in National Hospital for Tropical Diseases’ ICU department, said: "It is very hot and work can get quite stressful at times when many patients are admitted at the same time. This is the most challenging Covid-19 work I have participated in so far."

The doctor said that as of May 15, the department had treated 18 severe cases, including 15 ventilation cases, one extracorporeal membrane oxygenation (ECMO) case and two that needed breathing tubes. All the patients had different underlying medical conditions like end-stage kidney failure, heart failure, hypertension, diabetes and hemophagocytic syndrome. They needed support throughout with many interventions during the night, and the treatment getting more complicated in several cases.

Doctors becoming patients

Trắng đêm ở nơi tuyến đầu chống dịch

Inside the ICU of National Hospital for Tropical Diseases, Hanoi, on May 14, 2021. Video by VnExpress/Thanh Son.

Since Covid-19 infections have been recorded in the hospital, medics are at higher risk of being infected and becoming sources of transmission themselves. Even as the team stands alert to intervene for the patient, they also have to be psychologically prepared to become a patient at any time. The ICU has 50 staff on duty to treat Covid-19, including nine doctors, 39 nurses, one paramedic and one sanitation worker. Of these, one resident doctor and six nurses have come from another department to provide extra assistance.

Each night shift, there are two doctors and seven nurses. The number of medical staff mobilized has tripled compared to previous outbreaks.

"Many times, we still work as usual the next morning even after finishing the night shift. Everyone tries to look out for the other other and keeps pressing on," Phuc said.

"Sometimes, we feel like our body has almost given up on us. So we encourage each other to try harder," Nhung said.

Phuc said that the medical team in the ICU department stands prepared for all possible situations, anticipates and has backup plans for many things including a shortage of human resources.

Personally, Phuc has been quarantined four times in treating Covid-19 patients so far. He is familiar with the constraints of having to stay in the hospital for days on end and the stress of treating seriously patients. His biggest wish right now is for the epidemic to be controlled soon, to return home and to hug his daughter as soon as the quarantine is over.

Nhung nurses a similar wish – going home and hugging her daughter, only 13 months old, currently staying at home with her husband and grandparents. Every day, she calls home three or four times.

More than three weeks into the latest wave, Vietnam has had 1,836 cases in 30 cities and provinces.



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