29.09.2022

Why is it so difficult for doctors to leave the “red” zones and return to normal life

On the covid front line – a temporary truce. In the regions of the country, beds in hospitals are being reduced and hastily recruited residents are being demobilized. Now young doctors who have lived in hospitals for months and have seen death every day are returning to routine work.

“You walk in a suit – like a superhero”

When a medical student Nikita first heard about COVID-19, he did not attach any importance to the news: some kind of virus in distant China, in some market … Then Wuhan was quarantined, and the young doctor realized: everything is much worse than they say.

When the virus reached his city, Nikita was still moonlighting in a cafe.

– We closed on March 28. The director said that for two weeks. As a physician, I understood that they would not be enough. It was unstoppable.

Nikita went to work in a polyclinic as a district therapist. But when in the fall I heard that doctors were required in covid hospitals, I went for a blind interview. I went to the regional clinical hospital. The staff was not recruited there, but they advised to stop by the “twenty”. Have taken.

– Then we were already lying in the corridors. I walked in SIZ (anti-plague suit. – Ed.) And thought: “Where did I end up?” Another world. The scenes are like from a movie about the plague. Then I felt that [I was] in the right place. That this is not a joke and that something depends on me. Here are people – patients. I felt like a doctor in the “red” zone.

The young doctor took the death of the first patient hard. Others have lost count.

– I remember only one grandmother – the first. The day before, she felt bad, the doctors consulted, prescribed treatment. Then she felt better, she joked: “At least for a dance, doctor, maybe we can dance?” The next day I went [to the zone], and she felt bad, pulmonary edema began – foam, blood. They took him to the intensive care unit. I thought: “We’re in time.” Literally half an hour before my exit from the zone, they tell me that she is everything. I was nailed for a while, thought about her constantly, then decided: this is inevitable, it happens. We must save others.

In March, the physician fell under redundancies that began in the hospital against the backdrop of a decline in morbidity. According to Nikita, the doctors were so upset that someone even refused to go to the zone. For March, a schedule has already been drawn up for entering the “red” zone with the names of the doctors. It had to be redone in the middle of the month.

– I knew that it could end like that, but at least with the words: “Guys, you all will be fired, finish a month and get out.” But no. The elders said by what number to write the applications so that everything would come together on the salary.

After being fired, the physician could not recover for almost two weeks. Drank. Then I went for an interview at the polyclinic – they took the doctor of the “red” zone there with ease. And then suddenly they called from City Hospital No. 20, said that there were not enough doctors, and asked to come back.

– I was so happy that you can return! <…> But then I realized that it was too late. I already have a different path. My [former] colleague was not invited. He had something like a withdrawal: I will go myself. He was afraid: “I need this job, I want it back.” I understand him. Himself like that.

Nikita decided that he would stay at the clinic where he was admitted.

– And then today you need [in the hospital], and tomorrow they will be kicked out again. But I’m used to the zone. There is a ritual: you dress, stick up, walk in a suit – like a superhero. Here are your four hours [in the zone] – you live those four hours. I blissed out. In the clinic, he put on a robe and was like: Lord, is that all? Do not need anything else? Where are my chambers?

Anya came to work at Kovid from a polyclinic. In the fall, many of her colleagues went to work in the “red” zone – and she left too.

– The zone is, of course, a thrill. There was a lot of paperwork, we wrote epicrisis, but we also treated our own patients. We saw them every day, wrote them out, kept papers, made appointments.

Anya never regretted that she came to work in covid, but she was delighted to be downsized. By the spring, she was already feeling exhausted.

– My work in the hospital is a huge test for the relationship. I was unbearable. It happened to leave for work at seven in the morning, return by midnight. I just spent the night at home. What kind of life is there – cleaning, cooking? Every time I wanted to ask how the loved one was doing. He tried to understand me, but was amazed: “Are you so exhausted? Let’s talk, is everything all right between us? ” I snapped. I just wanted to lie with my eyes closed in silence, so that they would not touch me. And in the morning – back to the zone.

After being fired, the doctor tried not to think about medicine for more than a week, met with friends, slept until lunchtime.

– My house has turned into a courtyard. I wanted to cook again. I decided that I would somehow stay calm and unemployed. Moreover, financially I could afford this. And for about a week I celebrated my layoff.

On the weekend, Anya went to rest with her parents, then returned to her home clinic. A few days after that, she received a call from the covid hospital and called back.

– I realized that yes, the time in the “red” zone was priceless, but the last weeks were the happiest in six months. And I will not return for any paycheck.

You did your job

Armenuhi Katayan came to the covid hospital in November. This is her first job. The girl fell ill with covid in September with her whole family. She herself transferred the infection easily, and the grandmother was admitted to the hospital with a serious illness.

– I saw what kind of virus it was, and understood that we were needed. I got a job in the same hospital in which my grandmother was lying. I have disturbed sleep rhythms, it’s hard to get up in the morning. But I can’t say that I didn’t want to go to work. I was a day doctor: I went [into the “red” zone] for four hours, then I wrote the [illness] histories in the clean zone.

Katayan noticed that the condition of patients may worsen due to nervous experiences, and contact with a doctor helps to get better faster. The patients had no prejudice that they were being treated by too young doctors – they even regretted that the young guys walk in hermetically sealed suits and work in difficult conditions.

The resident resigned by the end of March. There were already much fewer doctors then.

– When there are many doctors, the work is divided evenly and there is no such amount of work. But there was no internal barrier that there were too many patients. You just go and do it. You create an algorithm in your head and act.

Armenuhi would like to continue working in the “red” zone, but sees this period as an important stage in her life and a reason for pride. The resident continues to study to be an ophthalmologist and plans to work in Aksai.

Sergei Sayenko was both a day and night doctor. Prior to the Rostov covid hospital, he completed an internship at the Taganrog infectious diseases clinic. The physician believes that a month in covid replaced him with six years of institute.

After being fired from covidarium, Sergei decided to continue the fight against coronavirus and returned to the Taganrog infectious diseases hospital.

– In the city hospital, it was originally set like this: guys, you have done your job, you must write a letter of resignation at this certain number of your own free will. We need to reduce the number of doctors. The flow has passed and such capacities are not needed.

If the patient becomes heavier, then withers away, says Sergei.

– I feel sorry for this patient and his relatives, but you cannot dwell on one thing, otherwise you will simply burn out. You need to fight further, because for one dead there will be ten, or even twenty saved, – says the doctor, who was lucky not to lose a single patient.

Sergei dreamed of the profession of a doctor from the age of ten. Now he is studying in residency, he plans to go to purulent surgery. Work in the covid hospital did not affect life plans.

Venereologist-dermatologist Valeria Maksimovskaya left the state of the covid hospital in March. The doctor posted a post in which she said that she assessed the last day of work as significant.

– Six months later – exactly six months – I leave the covid hospital, come back. I hope that my appointment as a dermatovenerologist will soon begin. Not an easy six months just with some wild trials and incredible people with whom I met. I can’t even believe that’s it, ”said the doctor.

Maksimovskaya stressed that her leaving the hospital was voluntary and she is looking forward to meeting her patients again on a medical profile.

– It was a new experience in working with intensive care patients in especially difficult conditions. It was psychologically difficult. Everything was aggravated by chronic fatigue at this pace of work. I enjoyed helping patients in the ways that were available. Now I have returned to the previous rhythm of work. It was not easy to rebuild, but now I understand how much we did not value the previous working conditions in pre-dock times, ”said one of the former resuscitators of the“ red ”zone.

Do doctors face post-traumatic stress disorder? Psychologists answer

– I immediately remember the film about Rambo: a man returned from the war and cannot get a job in peacetime, because he was under stress for a long time. You can apply this metaphor here as well, – says the practicing psychologist Roman Kryukov.

The specialist compared the young doctors who went through the “red” zone to the new recruits on the front lines – they saved lives, they were respected for their hard work.

– To know exactly how working in the “red” zone will affect doctors, you need to conduct research. But it can be assumed that doctors who have worked there for a long time may develop post-traumatic stress disorder with all the consequences. This is a great burden on the psyche and a regular meeting with death. Stress does not go away without leaving a trace.

According to Kryukov, Russian medicine has not yet faced such a challenge.

Anxiety specialist Pavel Zhavnerov believes that any doctor gets trauma in the first two years of training.

– Everything else is professional deformation. Many doctors treat death as calmly as a seamstress thinks that the seam is uneven. But there is another point: overwork. A person can perform a heavy load and not even notice how all his resources are being depleted. The load ends – and he [remains] with illness, fatigue and even panic attacks.

Zhavnerov advises doctors to return to normal life gradually: get more rest, go to bed earlier, and play sports.

– Doctors are people who strive to save, to find themselves at a turning point between life and death. They do it. They are appreciated. And then they say: “That’s it, you are no longer needed, collect tests in test tubes, write out prescriptions, listen to grandparents who complain about the same thing 15 times a day.” They [doctors] are returning to routine. They had military operations where they were needed and important, they felt their importance, they were proud of themselves. The very thing they were looking for in medicine when they entered the university.

It will be easier for people who have worked in their specialty for several years than for residents. After hospitalization for young doctors, routine can be painful, says Zhavnerov:

– It’s like in the song: “It is much more difficult not to go crazy with boredom and endure complete calm.” This is the hardest part. Doctors can become disillusioned with the profession. The purposeful person will remain.

Here the question is different – is everything so good that hospitals are being closed, and what if the disease will return?

Are hospitals closing early?

– Coronavirus hospitals do not disappear anywhere, they can be deployed at any time. And, accordingly, attract specialists. But so far the incidence is stable, there is no increase, [indicators in the country] – about 9 thousand cases daily. The number of patients requiring hospitalization is falling. And there is nothing wrong with the fact that these capacities will be re-profiled in other directions. This does not mean that if the incidence rate continues to grow, they cannot be quickly deployed, ”says Guzel Ulumbekova, rector of the Higher School of Economics, Doctor of Medical Sciences, professor.

According to Ulumbekova, in large cities – Moscow and St. Petersburg – about 40% of the population already have antibodies.

PLOT

“Besides, people in Russia do not live as crowded as in Europe or India. I hope that if the third wave does come, it will not let it run wild. Well, slowly, but still, the number of vaccinated people is growing.

The specialist argues that, if necessary, covid hospitals can be deployed quickly – within a few days.

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