Clinging to life in a Paris intensive care unit
Two hospital rooms, next to each other but separated by fate: In one, a COVID-19 patient still unconscious and weakening after five weeks of round-the-clock care. In the other, a man has just woken up, unsure where he is or what happened to his body, but saved.
Electrodes cover the awakened 60-year-old's sunken chest, and his face is a mosaic of red lesions after having a tube inserted into his windpipe to keep him breathing during three weeks in an artificial coma.
His eyes bulge with panic, but eventually they lock with those of a physiotherapist who has put on jazz music to cover the staccato of monitors and alarms at the intensive care unit of the sprawling Lariboisiere hospital in northern Paris.
The French word for the service, "reanimation," more clearly evokes what is at stake for the doctors and nurses fighting a virus whose devastating effects are still not fully understood.
"Reanimation is a very aggressive treatment, which is why we have to perform it with as much humanity as possible," Benjamin Chousterman, an ICU doctor at Lariboisiere, told AFP during a rare inside look at the fight to keep coronavirus victims alive.
"We have entered a phase where we have managed to save some of them, to allow them to leave intensive care, but there are still some patients who remain in extremely critical condition and who might not be able to leave," he said.
The service has about 60 beds, half of them brought in just a few weeks ago as it became clear hospitals were being overwhelmed in areas where the virus was spreading fast.
France had just 5,000 intensive care beds nationwide when the crisis hit, and officials have scrambled to set up thousands more since the first coronavirus infection was reported in the country in January.
As of Wednesday, about 4,200 COVID-19 patients were in intensive care nationwide, a number that has fallen steadily over the past three weeks from a peak of over 7,000 at the beginning of April.
The national total death toll has surpassed 24,000.
Health experts fear that an easing of lockdown orders from May 11 could spark a new flare-up in cases, since only a small fraction of the French population has been exposed to the virus.
- Baptism of fire -
At the other end of the corridor lies the COVID-19 patient who has been at Lariboisiere the longest -- six weeks in a coma.
Doctors are preparing the risky manoeuvre of trying to turn him onto his stomach. It is the fifth attempt and one of the last options for opening up respiratory passages when the lungs, constricted by inflammation, are not responding to other treatments.
But it is the first attempt for Luisa Oliveira, a nurse new to the service.
Rachel Ohanian, the colleague overseeing Oliveira's crash course, doesn't mince words: "These first two days are really going to do a number on you."
The instructions come quick -- keep all the catheters in place, untangle all the tubes and above all, make sure the blood oxygen and pulse monitor attached to his finger stays in place so the team can know whether the procedure is working or not.
They manage, but doctors are not optimistic. If there is no improvement soon, the next step will be to attach the man to a machine to start pumping blood artificially and injecting oxygen. But that is only a short-term solution.
- 'Survived the storm' -
"As with most infectious diseases like COVID-19, we don't have a cure, so the only thing you can do is keep organs functioning," Samuel Gaugain, a fellow ICU doctor at Lariboisiere, says after tending to another patient.
"He is 33 and hardly has any underlying conditions, only a little asthma, but he has a very severe case and has been in an incredibly serious condition for three weeks," Gaugain says of the third patient.
"He has lost 10 kilogrammes (22 pounds) of muscle mass but has taken on 10 kilos of fluid because of swelling."
Doctors have put the patient on tranquilisers to assuage the powerful nightmares and delirium that are common during long periods of intensive care, caught between waking and sleep and punctuated only by dozens of exams and tests.
Today the man's caretakers try slightly reducing the power of his ventilator machine to see if his lungs have regained capacity to function on their own.
But his blood oxygen levels plunge and the young man's eyes nearly burst out of their sockets in fear -- he is on the verge of respiratory failure.
"Don't worry, your diaphragm is still all worn out," Gaugain tells him, laying a hand on his arm. "You're young, you're tired, but it will come back. You've survived the storm."
The patient looks up but soon looks away, his face the image of despair.
- 'Surprised to be alive' -
Corinne, 50, runs a health and social services agency for the handicapped.
She is now recovering at Lariboisiere after she too came down with the new coronavirus.
"In the ICU, I felt like I was being crushed, with all sorts of injections, because I had an intubation, they put in catheters, and each person who comes in opens the bandage in his or her own way," she says.
"I was very surprised to still be alive, because when I was told what happened -- I actually thought that I was already dead and that they had managed to bring me back to life."
Since her ordeal, Corinne has savoured each sip of water, the thing she dreamed of while still in the throes of COVID-19.
"The hard thing is to have lost my autonomy, to see myself like this. When you've been working with disabled people for 20 years, it's a strange feeling," she says.
© 2020 AFP