One hospital’s Covid-19 diary: 'Every day and night we're dealing with death'
Even private hospitals, as well-resourced as they are, are being stretched to the limit by the surge in Covid patients, as Claire Keeton found out on a visit to a Mediclinic hospital in Cape Town
A23-year-old woman is wheeled into the Covid intensive care unit at the Mediclinic Constantiaberg hospital, an oxygen cylinder protruding from the blanket covering her.
A pair of nurses rush to her side, checking her vital signs. Hours earlier a 55-year-old man had died and now there is a bed for her.
At the moment, that is the only way a new patient can be admitted to this ICU, which filled all its beds over the past week. Later, another bed opens up in the ICU and the young woman’s father gets it. Her mother is downstairs, in a Covid ward.
It is Tuesday afternoon. The Cape Town hospital has given me permission to spend time in its Covid wards. Arriving at 11am, I have my temperature taken.
Mediclinic patient experience manager Renaldo Adams gives me an N95 mask with an advanced filter. We start at the emergency centre where Covid patients first come in, walking past the coffee shop and piles of blue scrubs to get there.
THIRD WAVE: Western Cape
• 73 - Deaths per day, current rolling average 1
• 3,737 - Deaths in the Western Cape
- Source: Western Cape government, July 16
FIRST STOP: THE EMERGENCY CENTRE
Before noon the emergency centre tends to be quiet, says Dr Shaun Mason, the emergency medicine specialist who runs it. In a sealed room that used to be the paediatric observation facility — bluebirds are painted on the wall — a patient is attached to a “rebreathing” device. His chest is barely rising and falling. This is the man who joins his daughter in the ICU that day.
Brawny ER24 paramedic Heinrich Africa has time for a quick chat while his crew take advantage of a lull to grab a meal. The paramedics are getting far more Covid calls now than in the first two waves, typically from people who have difficulty breathing and are “very sick”, he says.
“We had Covid cases here and there, but suddenly every case is Covid,” says Africa, the ER24 South Metro branch manager.
“Every day and night we are getting critical Covid patients. Every day and night we are dealing with death.”
Sometimes paramedics arrive at homes to find the person has already died. The speed at which Covid becomes life-threatening confronts paramedics, nurses and doctors daily.
Nursing sister Renisha Mahabeer, who runs the hospital’s Covid wards, says: “Covid seems to be more vicious this time round and patients change so fast. They come walking in with an oxygen saturation of 92 and within an hour their sats [saturation] can be under 60 and they are hypoxic.”
Hypoxia, or too little oxygen in the blood, is a dangerous symptom of Covid and supplementary oxygen is needed to treat it. Mahabeer found out for herself what it was like to be a patient in the Covid wards in August last year.
“I was spiking temperatures, confused and on a rebreather. I don’t remember five of those days,” says the sister, who wears a theatre cap with cheerful bunny ears.
“This is not like the common flu. This is a deadly virus.” Mahabeer has fully recovered, unlike some Covid patients who are struggling with long-term symptoms.
Mediclinic Constantiaberg is an organised and well-resourced hospital, yet even here health-care workers, particularly nurses, are stretched to breaking point after 16 months of the pandemic.
Vaccinations keep you out of ICU
• The UK reports that 30,300 deaths and 46,300 hospitalisations have been prevented thanks to vaccinations. About 60% of the population has had jabs
- Source: Public Health England Covid-19 vaccine surveillance report
In public hospitals — where nurses are responsible for about six times as many patients — the burden is even heavier. The emergency centre phone rings. A doctor from Namibia is on the line, looking for a Covid ICU bed. Mason is used to calls for help, but not from across the border.
“That is a first,” he says. When on duty, he usually consults on complicated cases, but it has become so busy lately that he has been working alongside his medical team on the floor.
“The patients all tend to arrive at the same time. Last night we got nine patients from 6pm to 8pm. On the weekend we got 22 patients in eight hours, and at least 50% have Covid.
“For every simple broken ankle, there are four or five complicated Covid cases. The numbers are higher, and the patients are sicker. Some of us haven’t had a break.”
When infections soar, Mediclinic Constantiaberg converts its surgical and medical wards into Covid wards.
2ND STOP: THE COVID WARDS
The Covid wards are separate from other units so you can’t end up there by accident.
From the emergency centre Adams guides me down “clean passages” that have been sanitised and are off-limits to everyone except staff. We enter the first Covid ward; laboured breathing can be heard from one or two rooms.
Some of the patients are elderly and frail; yellow-triangle “fall risk” warnings are attached to some doors. Other patients are middle-aged, mostly men.
A cancer patient with Covid, a nurse at his side, is gasping for breath in a room he shares with three others. Patients who do not need ICU care, or need to wait there for an ICU bed, are served by 15 high-flow oxygen points. Many have plastic tubes inserted in their nostrils.
“Patients come in and think, ‘I’ll be out of here in a day or two.’ I can see they will need a week or two,” says sister Tiffany Pienaar.
The hospital ramped up into Covid high gear last week, which included stopping procedures that require intensive post-operative care. “We thought the second wave was bad but this is going to be worse,” Pienaar says.
Mahabeer agrees: “The first wave was a walk in the park. In the second wave, there was a big incline. Now the numbers are rocketing up … We try to save as many people as we can.”
On Tuesday morning an elderly woman died, despite having appeared to be in stable condition for a few days. By the time we walked in at lunchtime, nurses had washed her body and triple-bagged it in plastic, as required. The undertaker’s team in white hazmat suits had taken her away, and the bed and room had been sanitised.
“We get emotionally involved with patients and it is very traumatic when they die. We are doing our best but it is scary,” nurse Viwe Mnana tells me in the staff tearoom.
Another young nurse sitting opposite her, Mpumezo Nonkala, says it is a shock every time patients die. “One day they are doing well. The next day you come on duty and they are no more. They are gone.”
Elderly patients refuse to listen to us sometimes and I have to tell them: ‘If you don’t do this, you will be dead'
In June last year, nurse Polina Hansdak got Covid but recovered quickly. Then, in the same month, her husband got very ill, his temperature spiking for days, and he was admitted to hospital and attached to a breathing mask.
“On the Friday they phoned me and said I better come in as soon as possible. I got a fright. We have a son of 10 and a daughter of four, and no relatives here. We came here from India,” she says.
“The first thing he said to me was ‘take me home’ but I could not. By Saturday he was on a ventilator and very confused. He did not know me or our children.
“I knew only one in three patients on ventilators survived. We had lost so many of our patients and even a few colleagues to Covid,” she says. But Hansdak refused to lose hope. After about a month in the hospital, her husband was discharged into her care.
For every health worker, the threat of Covid is close enough to touch. To protect their families, they wear blue scrubs during their shifts, which they leave behind for laundering when they go home.
The nurses wear N95 masks, visors, gowns, aprons and gloves when they go in and out of the rooms in the Covid wards to protect themselves. The two Covid wards at the hospital are above one another, linked by a staircase. The phones never stop ringing.
Pienaar, whose pink surgical cap has Hello Kitty patterns to cheer patients up, answers a call from an anxious relative, one of dozens she fields each day.
Cardboard biohazard boxes, with red warning logos, are lined up at intervals along the central passages.
“Patients may think they are fine to get up, and not listen to us, but when one man got up his sats dropped to 20,” says Pienaar. Patients on the ground floor who are strong enough may do “window visits” with their loved ones, a step up from the video calls that nurses and volunteers help to schedule.
A handful of patients in the beds are looking at their phones. But even patients who need no assistance in breathing cannot always sit up or eat, so a dietician monitors them to deliver feeding supplements.
In some beds, patients lie face-down on their stomachs to relieve their symptoms and speed up recovery, but others are unwilling to adopt that position.
“Elderly patients refuse to listen to us sometimes and I have to tell them: ‘If you don’t do this, you will be dead,’ ” says Mahabeer. She volunteered to run the Covid unit, whose oldest patient so far was 102 and the youngest 16. Both survived.
“I have a passion for nursing,” Mahabeer replies when I ask her why she chose to manage a ward that many nurses prefer to avoid. “With the medical ward being quiet during the first wave, I decided to take on a new challenge.”
She often has to tell a parent or a child that the person they love has died, and she still finds it difficult not to tear up then. Covid veterans like her and Pienaar are the backbone of Covid care, and both are vaccinated. A registered nurse, Pienaar does extra shifts on her days off, to lighten the load for the sister on duty.
“It is difficult to switch off when I go home. My mind is on the ward and the patients,” says Pienaar, who worked through December, including Christmas and New Year. At the peak of the summer second wave volunteers, including anaesthetists and surgeons, came in to assist with nursing duties.
Two psychologists and a social worker are also on standby to support the Covid teams.
THE FINAL STOP: THE COVID ICU
Entering the Covid ICU, personal protective equipment is compulsory. The nursing and medical staff, who do it every day or several times a day, are adept at donning the layers: blue scrubs; yellow gown; gloves; tape the wrists; more gloves; a cap and booties; and finally, a beak-like N95 mask, tight on the ears and forehead.
Death stalks every Covid ICU in the world, yet there is a surreal calm here, where the nurses move to the tempo of beeping monitors. Never stopping. There is one ward on each side of the corridor, with a total of 21 beds. The ward on the left seems quieter, with most patients lying unmoving on ventilators and medically comatose. Only one of the 10 in this ward is female.
Patients’ oxygen saturation levels flash in blue on big screens. Even on full ventilation, one patient’s level dips to 63, a warning that he might not make it. Two people died at about lunchtime in the other ward, right before we came inside. But it’s not all bleak.
We are tired and tomorrow we are expected to put on our flight suits and do it all over again
Patients do improve, like one scrawny pensioner whose first wish after reviving was to watch the Uefa Euro Championship final. Next to him, a patient is having fluid suctioned out of his lungs. Two women patients are alert, their eyes tracking the nurses. They operate smoothly under nursing sister Wendy McLeod, who is in charge of the ICU.
When emergency physician Dr Shiraaz Shaikjee walks in to insert an arterial line — to measure blood pressure, oxygen levels and easily draw blood — in a young patient, the nurses are at hand to assist.
Shaikjee, who has written his name on his gown, brings a wave of warmth and gentleness in with him. He is highly responsive to calls for help from the Covid ICU teams, multiple times a day.
And every day now there are more.
THE NUMBERS ARE REAL
“Covid numbers are not made up. Every time the reported numbers go up, our numbers go up,” says Pienaar. “But nobody knows what it is like unless you are working in a hospital. And people should know that just because you have money or medical aid, you are not guaranteed an immediate bed.”
Africa, whose team comprises four ambulances and 20 staff, all vaccinated, says: “Hospitals have limited capacity and we are seeing a huge influx of patients. The third wave is coming at us at a very fast pace. We are tired and tomorrow we are expected to put on our flight suits and do it all over again.”
While he is speaking, the doors to the emergency centre open and Africa rushes forward, to help push a woman with seizures into the resuscitation room. Non-Covid medical emergencies do not come to a stop because of the pandemic.
Tuesday started with the birth of a baby boy at Mediclinic Constantiaberg. By the end of the day, seven Covid patients had died. They were seven out of the 633 people who died of Covid in SA on July 13.