‘Behind this door, seven out of 10 patients die’: Distress and heartbreak at a COVID-19 ward

Coronavirus cases are flooding the intensive care units at Beirut’s Rafik Hariri University Hospital

‘Behind this door, seven out of 10 patients die’: Distress and heartbreak at a COVID-19 ward

A Lebanese Red Cross ambulance parks in front of Rafik Hariri University Hospital. (Credit: Mohammad Yassine/L’Orient-Le Jour)

It’s 12:30 p.m. at the Rafik Hariri University Hospital. A Lebanese Red Cross ambulance has just parked in front of the emergency room. A first-aid worker, clad in protective gear, approaches the waiting nurses. They look distraught.

The first-aid worker explains to them that the man who has just been carried out on a stretcher from the ambulance has COVID-19 and needs to be admitted. But there is one major problem: RHUH is full and cannot accept any new patients.

The coronavirus patient, age 65, is lying in his sweatpants on a stretcher. Barefoot, he is getting agitated. His hands grip the metal side rails of the stretcher. His face looks contorted with pain. He takes off his mask because he can’t breathe anymore. He tries to get up several times, gasping for air.

Leaning on a cane, his brother stands next to him. “If I take him back home, he will die,” he says with a tremble in his voice.

“The Red Cross called all hospitals; we went to four of them. They all had the same answer: we have no room,” says the brother. Next to him, the first-aid worker appears to be losing his cool.

“We’re going to leave him here,” he shouts, before turning on his heels and quickly climbing back into the white and red ambulance. As the vehicle takes off, its wheel brushes against the old man causing him to cry out.

The Red Cross first aid worker’s reaction was nothing but an expression of his extreme frustration. Since the New Year’s celebrations, there has been a massive spike in coronavirus cases, with numbers hitting a daily record of 5,440 new cases on Jan. 8. Hospitals are barely keeping up with the increasing number of hospitalizations, and first responders are feeling helpless.

The patient and his brother are still in front of the ER entrance. “Please take him in, put him in a hallway at least,” the brother begs. “What kind of a hospital is this? Are you going to let him die?”

Some nurses enter the establishment. The brother follows them. “I have a patient that needs to be admitted to the hospital, why are you not taking him in?” he snaps at them in confusion.

Therese, an ER nurse at the COVID-19 unit, tries to explain to him that all the beds are occupied.

“This is the first time that we have to tell a patient that we no longer have any free beds. It is not how things naturally go. But it is not my decision. There is nothing else the Red Cross could have done. This is just the beginning,” she says in dismay.

“He is right. I would have acted the same way if it were my brother,” Therese adds.

‘What am I going to do if I have two critically ill patients of the same age? Who will I choose?’

RHUH is one of the front-line hospitals in the fight against the pandemic. It has four ICU wards, including one at the ER, with around 40 beds, soon to be 50. These units have received 455 patients since the outbreak of the pandemic in February 2020. Next to the ER, in the same white building, people are lined up to get tested for COVID-19.

The smell of sanitizing substances, used for disinfection, permeates the hospital emergency room. All beds are occupied. In the middle of the room, the nurses are at their counter, in front of their computers, talking among themselves. Behind them, there is a room where all their protective gear and clothing is stored. This is the “clean zone.” No person can enter the room if they have been around a potentially infected patient.

Here, the telephone keeps ringing. In the background, one can hear the patients’ coughing fits and the beeps of the machines connected to the their ailing bodies.

A little boy, barely 5 years old, is curled up on a bed, all alone. He is potentially positive. A few minutes earlier, he kept coughing and clutching the bed’s metal side rails. Handkerchiefs soaked in vomit can be seen under his left cheek. A nurse comes to cover him with a blue blouse to warm him up as the temperature is cold in this part of the hospital. He no longer has the strength to move.

Around him, other patients cling to the masks that help them breathe. Each bed has access to an oxygen source and is separated from the next bed by a false wall.

To the little boy’s left, an old man is half-lying on his bed. He clings to his respirator as if it were a lifebelt.

There is a glass room on the right-hand side of the ER entrance. A woman in her 40s has been placed there as there are no free beds on other floors. She is also on a respirator. Her hands are tied with white plastic bags to the bed’s metal side rail so that she does not unconsciously pull out the tube attached to the respirator. She is moving her head from side to side as if she is gasping for air. She gazes into space as she mutters inaudible words.

At the ER, the nurses are exhausted. They are caring for 15 patients, six of whom are in critical condition. “Five people on our team have tested positive. We are more than understaffed,” explains Therese. But the team appears to be solid.

Hussein Kataya, a nurse in charge of the hospital’s “coronavirus emergencies,” was infected by the virus a few months ago. “Hussein was in critical condition. But he wanted to stay with us instead of going to the intensive care unit,” Therese says.

“Yesterday we had to treat a patient outside the hospital because there was no more room. It brought tears to my eyes,” Kataya recounts. Like many others, he fears that the worst is yet to come. “What am I going to do if I have two critically ill patients of the same age? Who will I choose?”

‘When a person makes it out alive, it feels like New Year’s for us’

On the first floor, before entering the intensive care units for the most critical cases, a team of paramedics monitors patients via a screen.

Behind this door lies another world. “Here, there is death,” says Sylvana, an ICU head nurse.

The situation weighs heavily on nurses who work tirelessly for a minimum of 12 hours per day. There are two shifts: 7 a.m. to 7 p.m. and 7 p.m. to 7 a.m.

“I work 27 days a month, sometimes seven to eight days in a row,” says Abdallah, a 31-year-old nurse.

For his part, Hassoun, a doctor, and head of the intensive care and pulmonary department, tells L’Orient-Le Jour that sometimes “the team members feel useless and hopeless. A colleague of mine broke down in tears when a 37-year-old patient of hers died.”

Seven out of 10 intubated and ventilated patients die once they pass through this door.

“When a person makes it out alive, it feels like New Year’s for us,” Hassoun says.

In this frightening part of the hospital, precaution and vigilance are keywords. A member of the medical team returns to the ICU after having taken a PCR test. He had chills and was running a fever.

Here, paramedics are protected from head to toe with reusable personal protective equipment: only their eyes are visible.

In this room, where the temperature is low due to the negative pressure, silence is interrupted only by the sound of oxygen machines, the telephone and other medical machines.

“The monitor beep is messing up my mind. I can hear it all the time. Sometimes when I’m at home, and the phone rings, I pick up the receiver and say, ‘Intensive care, hello,’” Sylvana says jokingly.

These monitors indicate the patients’ heartbeats as well as oxygen levels. They are connected to a control panel that sounds an alarm if something goes wrong.

It’s 1 p.m., a rush hour for the medical team. Leila, 26, is about to enter a patient’s room to administer medicine.

“We’re used to it now,” she says as she puts on her second pair of gloves, goggles, a gown over her personal gear and a second face mask. She has been working in this unit for five months now.

“We put our heart and soul into our work, while the majority of patients [who are in critical condition] do not make it out alive,” she says.

Next to the room, in front of the counter, four people from the medical team are chatting. A man, standing more than six feet tall and dressed in a green blouse, cracks a joke, making his colleagues laugh in front of a patient’s room.

“I sometimes think that they should not talk so loudly, but we only allow ourselves to have a few moments like this during the day,” Sylvana says.

Inside the patient’s room, Leila carefully administers medications to the patient who gasps as she breathes. When she comes out, the nurse takes off the first pair of gloves, then the blue blouse, and then washes her hands meticulously, rubbing between her fingers and focusing on her nails and her wrists. She wipes her hands with a tissue, throws it away and closes the tap with another tissue, before finally disinfecting her hands with sanitizer.

‘He is an athlete; he has no medical history’

A few minutes later, Hassoun, the doctor, holding a piece of paper in his hands, begins his tour of the room. His team members accompany him, not taking their eyes off him.

He provides information on patients: physical examination, blood test, positive changes, fever, vital signals. The doctor and his team discuss how to proceed for the day and for the next day.

“Before the coronavirus, I did not look like this,” he says, smiling. He is 35 years old, but the bags under his eyes are hollowing out his face.

“I don’t like my patients to see me like this,” he adds. The patients are isolated in their glass rooms with sliding doors. Their faces are hidden under the tubes. At the front of this section of the floor, there is a table containing drugs for 10 patients aged between 11 and 85 years old. Six of these patients are sedated. They are motionless.

“They are on mechanical ventilators, so they don’t suffer. We are giving them air,” explains Hassoun.

“We change their position every three hours,” adds Sylvana. Three are awake. The others are asleep. Some of them have two tubes, one through their mouth connected directly to their windpipe, and the other through their nose to feed them.

In the first room on the left, a young man, barely 25 years old, lies in bed. “He is an athlete; he has no medical history,” says Abdallah, a 31-year-old nurse.

Next to the young man, another man is wearing an oxygen mask. His face and eyes are swollen with visible signs of fatigue. He makes a video call to his relatives and coughs through it.

“Wifi is available on this floor. For [older patients] who do not know how to use [technology] tools, we have a laptop with Skype so they can call their relatives,” explains Sylvana, who waves at a patient through the glass. Her mask hides her smile, but her eyes light up as she greets the 11-year-old, whose mother is keeping him company.

“He was crying all the time. I thought that it was not possible to leave him [here] all alone. I asked the doctor if we could allow his mother to visit. We talk to him every day, but we do not have the time to stay by his side all the time,” Sylvana says.

For these front-line nurses and doctors, the virus seems ubiquitous, even outside the hospital walls.

“We fear that we might infect our loved ones. I am not seeing my niece or my mother-in-law. Every time we enter a room in the hospital, there is a kind of barrier with the patient set by this invisible enemy, prompting us to be vigilant in every move we make,” Sylvana says.

In another room, a 32-year-old patient is hanging between life and death. She was pregnant when she arrived at the hospital, but she does not yet know that she has lost her child. With tears in her eyes, Sylvana says, “She asked about her baby. We told her that he was fine.”

She stops talking for a minute, takes a deep breath, beams at the patient, and says with a lump in her throat, “That woman was awake and talked to us. She asked us to give the news [of her baby] to her husband. When I am here and think that people outside continue to go out as if there were nothing, I don’t know what to say.”

Many medical professionals had castigated the government’s slackening of anti-COVID-19 measures at the end of the year, warning of the consequences after the holidays.

‘Some people might think we are criminals’

Back in the emergency room an hour later, the boy who looks about 5 years old is now wearing a respirator. He takes small breaths and his chin is twitching. A relative is now sitting by his side.

It is now 2:20 p.m. Outside the ER, the 65-year-old patient is still waiting. “What can we do?” says Therese, with a tight throat and tears in her eyes.

The man tries to get up and is gasping for air. His brother is sitting in a chair next to him with his head bowed, hoping that a bed in one of the intensive care units will free up.

“People might think we are criminals if they saw this man here outside. But we don’t have any free beds left. I keep making calls so we can admit him,” Kataya says.

Nurses and a security worker try to place the sick man in the shade on the sidewalk by the emergency room entrance. He squirms in his stretcher and glances at his watch. It’s 3 p.m. A nurse shouts, “A woman is leaving the hospital!”

At 3:30 p.m., the old man is finally admitted. His brother tries to follow him but is stopped by another nurse. “How will I know if he is going to be OK?” he asks, distraught. “We will let you know. You can stay outside,” the nurse replies. “Be patient,” says the brother, looking a little disoriented.

Another Red Cross ambulance pulls in. This time it is transporting a COVID-19 patient back home. The patient comes out with his relatives, a woman, a child and another man. They take a selfie together next to the ambulance and the luggage on the ground. One last memory of the hell they had to go through.

“We’re going to have to make some tough choices,” Kataya says gravely.

“If things continue like this, with the shortage of beds and ventilators, patients will end up in the hospital wards,” Sylvana adds.

With the pandemic, the health sector, which has already been undermined by the economic crisis, is collapsing.

“We are going to face the same scenario as in Italy. People will die in their homes or at the hospitals’ doors. We will no longer have any place left,” Hassoun says.

“With the massive spike in cases, hospital teams will burn out under the pressure of work. If exhausted, paramedics might make errors and put themselves in danger. We have been fighting this virus for 10 months. I am afraid that one of us will die, which would put everyone else off,” he adds.

This article was originally published in French in L’Orient-Le Jour. Translation by Sahar Ghoussoub.

It’s 12:30 p.m. at the Rafik Hariri University Hospital. A Lebanese Red Cross ambulance has just parked in front of the emergency room. A first-aid worker, clad in protective gear, approaches the waiting nurses. They look distraught.The first-aid worker explains to them that the man who has just been carried out on a stretcher from the ambulance has COVID-19 and needs to be admitted. But there...