Tuesday, April 20

24 hours in the ICU: Fighting for an open bed in Covid-19 hit French town


Four more calls to go, each with careful words, painful silences.

It’s 2 p.m. in the intensive care ward of Marseille’s La Timone hospital, and Dr. Julien Carvelli is phoning families hit by the second wave of the coronavirus with news about their children, husbands, wives. With intensive care wards at over 95% capacity in France for over 10 days, Carvelli makes at least eight of these difficult calls a day.

In Marseille, this wave is bringing even more people to the ICU than the first one in the spring, many in more severe condition. Carvelli warns one father that his son may need to be put into a coma.

“For the moment, he’s holding on. But it’s true that — I don’t know what you’ve been told already — his respiratory state is worrying,” Carvelli acknowledges. There’s a long pause on the other end.

“Listen, do your best,” comes the strained reply at last.

France is two weeks into its second coronavirus lockdown, known as “le confinement.” Associated Press journalists spent 24 hours with the intensive care team at La Timone, southern France’s largest hospital, as they struggled to keep even one bed open for the influx of patients to come.

The doctors and nurses tell themselves and each other that they just have to hold on a little longer. Government tallies show infections may have reached their second-wave high point, and hospitalizations dropped last weekend for the first time since September.

But the medical workers are also frustrated that France did not prepare more in the months after the first wave. And while doctors and nurses were seen as heroes back then, this time is different.

“Before, they applauded every night. Now they tell us it’s just doing our job,” says Chloe Gascon, a 23-year-old nurse who has spent half her 18-month career under the shadow of coronavirus. Her voice carries more than a trace of bitterness.

Marseille has been submerged with coronavirus cases since September. The port city, on France’s Mediterranean coast, was spared the worst of the virus last spring only to be hit with a vengeance as the summer vacation wound down. Bars and restaurants closed across the city on Sept. 27, more than a month before they shut down nationwide. It wasn’t enough.

A decade of budget cuts left France with half the number of intensive care beds this year, when it needed them most. By the time the first confinement ended on May 11, more than 26,000 people had died in France. The government pledged to take advantage of the expected summer lull to add beds and train reinforcements.

That was the time to act, when new infections were at their low point, said Stephen Griffin, a virologist at the University of Leeds.

“It was always bubbling away under the surface,” he said.

But it was only in early fall that work started on refashioning an acute care wing at La Timone, which opened less than two weeks ago and still has exposed wiring and a fiberboard barricade with duct tape. The promised reinforcements have been slow in coming as well, and any training they get is in the moment, as Pauline Reynier is learning during her first week as an ICU nurse.

Compared to the emergency room, the ICU is a relatively calm place, with moments of urgency when a patient needs more oxygen or an intervention. The quiet is punctuated by the constant soundtrack of machines beeping. There is no good news here; the best news is that a patient is stable enough to be moved elsewhere.

When the 12-hour nursing shift starts at 7 a.m., all 16 beds are filled with COVID-19 patients, and five are conscious. For those in artificial comas, it takes about an hour and at least two people to wash and then carefully rotate each one in their beds, keeping the wires and plastic tubing in place.

This is Reynier’s first task.

She helped in a regular coronavirus ward during the first wave and offered to retrain over the summer for intensive care. Instead, the 26-year-old was sent back to cardiology, which was filling with patients who had postponed heart surgeries. It was just a week into the second lockdown that the call came to report to the ICU on November 11, a lightly staffed national holiday.

It is only Reynier’s second shift as an ICU reinforcement. Her new colleagues barely know her name and have little time to teach. The daughter of a nurse who also works at La Timone, she largely learns by watching.

It takes months to train as an intensive care nurse, years to become experienced in the gruelling specialty of holding death at bay.

This virus is even more demanding than the usual urgent challenges. Caregivers risk nearly as much as the patient, and dress accordingly, each time they enter a room. And so going to the bedside means planning multiple tasks at once: washing, toothbrushing, checking vitals, changing IV drips and, finally, turning the patient over to help improve breathing.

Reynier pulls on a long-sleeved apron over the scrubs with a quick twist of the wrist to knot the neck. Then a pair of gloves. Punch a thumbhole through the bottom of the sleeve to secure the gloves, then pull on a second pair of gloves. Head covering, goggles and, finally, a second apron in plastic. X-ray technicians wear a third set of gloves to handle the plates. Doctors performing an intubation or other major procedure wear a plastic face shield over the goggles.