'I turn off the ventilator for the hopelessly ill': a confession from a nurse fighting Covid-19

For many patients with acute Covid-19, timely connection to a ventilator is often a matter of life and death. However, even this device does not guarantee salvation, and doctors around the world have to make difficult choices, turning off mechanical ventilation in cases where there is no longer any hope, writes with the BBC.

Photo: Shutterstock

“Disconnecting the device is emotionally very difficult and very painful. Sometimes it even seems that I am personally responsible for someone’s death,” admits Juanita Nittla.

Juanita was born in southern India but has worked in the British National Health System (NHS) for the last 16 years. She is a senior nurse in the intensive care unit at London's Royal Free Hospital. Nittla, 42, often finds herself in situations where doctors have no choice but to stop keeping the patient alive using mechanical ventilation devices.

The last will of the dying

One day in early April, when Juanita came to the morning shift, the head of the department announced that she would have to interrupt the treatment of the patient with Covid-19. The patient was also a nurse, a woman over the age of 50. Juanita had to explain to her daughter what this procedure would consist of.

“I tried to reassure the girl that her mother was not in pain and felt quite comfortable, and also asked if the patient had any last wishes, including religious ones.”

In the intensive care unit, the bunks were next to each other, and in addition to the dying patient Nittla, there were other patients who were also unconscious.

“She was lying in a box with eight beds, everyone there was seriously ill. “I closed the curtain and turned off the sound notifications on the appliances.”

All the medical staff in the room froze for several minutes.

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“The nurses were silent because human dignity and the comfort of patients is our first priority,” says Nittla.

Then she brought the telephone to the patient’s ear and gave her daughter the opportunity to say mother’s farewell words.

“It was just a phone call to me, but it meant a lot to her family. Of course, they would like to be able to make a video call, but, unfortunately, the use of mobile phones is prohibited in the intensive care unit.”

Off

At the request of the dying relatives, Juanita turned on the music video clip of their choice on the computer, and then turned off the ventilator.

“I sat next to her and held her hands until she died,” says the nurse.

The decision to discontinue treatment and disconnect from the equipment is made by a group of doctors only after a thorough assessment of the patient’s condition, his age, medical history, reaction to the course of treatment and the chances of recovery.

In the case of Nittla, her ward died five minutes after the ventilation was turned off.

“I saw how alarm signals began to flash on the monitor, and then the cardiogram showed a solid straight line on the screen - the heart stopped beating.”

Death alone

After this, the nurse disconnected the droppers that supplied sedated drugs to the patient's blood.

At the same time, the patient’s daughter, not knowing what was happening in the room, continued to say something to her mother on the phone and read prayers. With a heavy heart, Nittle was forced to pick up the phone and report that it was all over.

However, according to Juanita, with the death of the patient her duties do not stop.

“With the help of my colleagues, I washed her, wrapped her in a white shroud and placed her body in a special bag, but first I painted a cross on her forehead,” explains the nurse.

Before, relatives were also allowed to be in the intensive care unit when the life-supporting equipment was turned off. However, due to the current situation in most countries of the world, this practice is now canceled.

“It’s sad to watch people die alone,” Nittla says, and admits that helping the dying helps her cope better herself.

Lack of beds

Due to the large influx of patients, the intensive care unit of the hospital was expanded from 34 to 60 beds. Now they are all busy.

An entire army of 175 nurses is working in the intensive care unit.

“Usually in intensive care the ratio is one to one, but now there are three patients for every nurse. And if the situation continues to deteriorate, then for every nurse there will already be six patients.”

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Some nurses showed symptoms of coronavirus, and they went into self-isolation. I had to reassign nurses of other specialties to work in intensive care.

“Before each shift, we hold hands and say like a mantra: “Let everything be fine.” We look out for each other, make sure everyone is wearing gloves, masks and other protective equipment,” says Nittla.

In the hospital there is a shortage of ventilators, infusion pumps (for dosed administration of drugs to patients), oxygen cylinders and many necessary medications.

Fortunately, the clinic has enough personal protective equipment for all staff.

On average, one death per day is recorded in the intensive care unit, which is much higher than the average level before the pandemic.

“It’s very depressing,” Nittla admits, “I have nightmares, I can’t sleep, I think I’m going to get infected, I talk a lot with my colleagues, and they’re all afraid.”

Last year, she suffered from tuberculosis for several months and is well aware that the possibilities of her lungs are severely limited. But she, as a senior nurse, sometimes has to suppress her own fears.

“They often tell me that I shouldn’t go to work, but now there’s a pandemic, and you have to forget about everything and do your job.”

“At the end of my shift, I always think about the patients who died that day, but I try to switch to something else when I leave the hospital walls.”

As ForumDaily wrote earlier:

• Coronavirus Medicine: perhaps treatment for COVID-19 has long existed
• Can coronavirus penetrate the skin: 5 important questions about 2019-nCoV
• WHO: mass wearing masks does not save from coronavirus and may even harm
• 'They Are Pressing Us Strongly': New York Nurses frankly told about work during the COVID-19 epidemic

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