DIGNITY: Nurse, Laure Madé
Laure Madé (FRANCE) , is a practicing
Covid-19 Nurse at Hospital Bichat, Paris and Epidemiologist. Trained as
a nurse in France, she completed a MSc in Epidemiology at the London
School of Hygiene and Tropical Medicine. She has been working on
emerging infectious diseases at Institut Pasteur, the University of
Liverpool.
I worked as a nurse in a Covid-19 ward in a French hospital in Paris
during the Covid-19 outbreak. The Bichat hospital is a referral hospital
for the treatment of emerging infectious diseases and a leading player
for the management of epidemic and biological hazards. During this
unprecedented sanitary crisis, I witnessed numerous situations where
health professionals faced ethical dilemmas in human lives. After
fighting tirelessly against Covid-19 in France and oversea, I am still
wondering whether we can effectively control this outbreak while
treating both patients and the deceased with sensitivity, dignity, and
respect.
In early April 2020, we were overwhelmed with Covid-19‘s media coverage.
Many patients in an artificial coma were exposed to French TV news as an
attempt to raise awareness of the threat of the unseen virus. In France,
patients have to give consent to appear on TV, but this is not mandatory
if they are unconscious as long as their face is covered. According to
French law, the consent of the people filmed is not required when the
image is illustrating a topical subject. I did not experience this
specific situation as I wasn’t working in the Intensive Care Unit, but I
know some colleagues who felt uncomfortable dealing with this specific
situation and found it particularly inappropriate.
We experienced other dilemmas during the outbreak that went beyond the
media issue. What called my attention was how the patients were
extremely terrified by being infected with Covid-19. It was indeed a new
disease, very contagious with no proven treatment available. Every
single health worker was entirely covered up with protective personal
equipment: mask, gloves, gown, cap, glasses, and so on. All doctors
looked similar and patients couldn’t differentiate the many different
nurses. This was a very stressful environment for them. On top of that,
we could not enter the Covid-19 rooms as often as we wanted because we
had to restrict our visits to limit the risk of contamination. Relatives
and close friends were denied access for the same reason. In many rooms,
Covid-19 related news was displayed repeatedly on TV screens leaving
these patients with feelings of loneliness, isolation, and fear. They
were fortunately allowed to keep their phones with them and could,
therefore, maintain a much-needed virtual contact with their loved ones.
Despite these challenges, we tried our best to reassure them, and we
made sure to provide emotional support every time we interacted with
them.
The fact that our country was unevenly affected meant that a lot of
human and material resources were allocated to the most affected areas.
We did not experience a lack of staff, as hundreds of health workers
came to help from different cities, including medical and nursing
students. We were lucky to have at least one nurse for every four
patients in the Non-Intensive Care Unit. However, we had severe issues
accessing personal protective equipment, especially appropriate masks
(34). This was a major challenge because we really wanted to give the
best care possible to our patients, but we also needed to feel safe and
protected ourselves. We had an incredibly high number of sick
colleagues, and we even had to resuscitate one of them who was
hospitalized in our ward. The feeling of fear was shared by everyone,
patients, and health workers alike.
Finally, Covid-19 protocols in place at the time also impacted the way
we handled the deceased bodies. Whenever we had a death in our ward,
which was unfortunately frequent during the outbreak, we had to put the
body entirely naked in the mortuary bag (35). This situation was
distressful as we felt that we could not honor the deceased properly. We
were not allowed to dress them up and the family was not allowed to view
them. The rationale behind this recommendation was to limit the risk of
contamination after death even though no evidence of transmission of
SARS-CoV-2 through the handling of the body of a deceased person has
been documented. The French High Council for Public Health amended its
recommendations end of March (36) when the risk of infectious
transmission from bodies was proven to be lower than for living
patients. They allowed the viewing of the body for mourners immediately
and the presentation of the body to the family. However, these less
stringent guidelines did not reach our hospital.
During this pandemic, health professionals faced ethical dilemma
situations more frequently due to various factors such as time required
for the healthcare system to adjust to the crisis (hiring extra staff,
set up of space/beds for patients, procurement of appropriate protective
equipment, etc.), intensive workload among others, and potentially
impacting the standard of care. But despite this stressful period, our
intent was always to keep humanity in the care provided. Finding the
right balance between the need to control the infection and the respect
of the patients and families’ rights is a difficult exercise, but the
dignity of the patients and the deceased should be respected and must
remain a priority, even in such chaotic time.