140 patients for 86 beds in La Paz emergency room at rush hour: “Either they give me the medical report immediately or I will be shot” | Madrid | spain

84-year-old Estrella, a resident of Madrid, fell ill at a bad time. This Wednesday she felt dizzy and vomited, so her husband accompanied her to the emergency room of a La Paz hospital. They arrived at 2:30 pm, one of the worst days to enter through the sliding doors facing Paseo de la Castellana. Her husband watched as Estrella was taken to one of the intensive care units, a place where access to companions is restricted during peak occupancy. It was one of those moments of saturation. He avoided her gaze and remained in the waiting room, waiting for his name to be called.

At 3:00 pm, six congregate rooms with 86 beds each are filled with 140 patients. Elderly sick people lie with their faces open on extra beds in the corridors; Other patients have been seated on blue chairs and are breathing with the help of masks attached to oxygen cylinders. Two patients have been waiting to be taken to the ward since New Year’s Eve.

An angry man’s voice is heard over the public address system, asking his family members to come out. The reason for the evacuation is that health workers need space to work. “We ask colleagues to vacate the observation room and hallway. Go back to the waiting room!”

This Wednesday something extraordinary happened: the guards were left without “furniture.” In the jargon of emergency personnel, furniture is extra beds and chairs to accommodate new patients. Worst of all, it will be difficult to fill vacancies because they are dependent on new employees coming to the plant, which usually happens in the morning, when more employees are working. Theoretically, a patient should not spend more than 24 hours in the emergency room, but sometimes they have to wait as long as two or three days.

In the emergency room, patients have no privacy and have to share the bathroom with dozens of people. Extra beds and chairs do not have light and oxygen outlets.

Some health workers here insist that the cause of this collapse is not the flu pandemic but the lack of foresight of their bosses, who let them down with their response to the avalanche of infections winter after winter. As one nurse explains, if you have a leak, you can’t blame the rain.

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The heat is so intense that employees have left some windows open; The noise reaches 88 decibels, as one nurse demonstrated on her cell phone: “This is a higher level than the bus station.” Seems like beep, beep, beep Cardiac monitors, patients calling over the public address system and the screams of health workers trying to locate the sick.

—Where is Jose Ramon?

“Here, in the hallway!”

The emergency room has six acute rooms. The largest is the third, which has 32 beds, but at 5:00 pm it has 49 patients. An older woman sits on the help of two toilets and lets the rest of the room see her naked back, covered only by a diaper.

On the other side of the room, a 68-year-old former civil guard arrives with his daughter, who suffers from mental illness, and claims that a relative “tried to rape” her on New Year’s Eve. The father demands that a young nurse give him a medical report in order to file a complaint.

“Either they give it to me immediately or I join in the shots here.”

“No man, don’t get into shooting here,” she replies calmly.

“No, no, with you, no.

The health workers ask the man to go to the waiting room, but he explains that he cannot leave his “girl”, who is waiting quietly in a chair wearing a white-star fleece and a pink fanny pack, alone. “I’ve been kicked out before, but my daughter is nervous and asks me ‘Dad, please don’t go’ and I have to console her,” says the father, with messy brown hair and bushy eyebrows. “He has put his hands in my girl’s body parts and the man has not been detained. “I shot him.”

The man refuses to leave and the health workers ignore him. There is no police to maintain order here. There are just a few security guards who intervene when the situation goes out of control. The former Civil Guard’s threat to shoot is, apparently, a minor incident that does not necessitate a call for help. The affected health worker recounts what happened minutes later as if nothing had happened. She has seen worse things in all her years working here, she says: “I’m sure the number of strikes in this service is many times higher than any other plant service. We are very helpless, but the relatives demand proper attention which you cannot give them.”

Sometimes they have to deal with mentally ill patients who become violent. In another room, an elderly woman gets out of bed and disappears from sight. Paramedics found him locked in an office shortly afterward.

More than 600 people passed through a La Paz emergency room on Wednesday. There are a large number of mildly ill patients who wait in the waiting room to be called for consultation and then go home. Patients are seen by a triage team that evaluates the severity of the case according to a color scale (blue, green, yellow, orange and red). These are the last three colors that move into rooms and become saturated.

Organize “chaos”

Health care unions blame poor planning and a lack of will to find solutions for the collapse. They point to general problems, such as a general shortage of doctors or the worsening of neighborhood emergencies, where the only nurses who often refer the most serious patients to hospital are often of service. Emits, the majority medical union in Madrid, says the emergency room collapse is not limited to La Paz, but they understand that its prestigious image as the great reference hospital for Spanish healthcare makes it worthy of all the headlines. A spokesman, Daniel Bernabeu, regrets that they have been waiting four years for a complete reconstruction of this old center since 1964.

Another health group, Workers in Network, cites the lack or poor management of 72 hospital beds in La Paz over 10 years, which has led to a 20% increase in the number of staff this winter, leading to a 4% increase.

The Health Ministry responds that the situation in La Paz is typical of the beginning of a seasonal flu epidemic to which other respiratory viruses join. A spokesperson says the hospital management has opened 44 beds in the hospitalization floors and another 10 beds in the emergency department. In addition, he says, there is a possibility of transfers to the Carlos III and Cantoblanco centers belonging to the hospital complex in La Paz, and the number of patients treated by the home hospitalization unit has also increased.

However, conversations with a dozen employees reveal dissatisfaction with management. “The only thing left for us is to organize this chaos,” says one man, who like the others has requested anonymity to avoid reprisals. “The biggest problem is that we already knew this was going to happen for 15 days, but no measures were taken until it was blown out of proportion and patients walked out the door.”

The stress they face also harms their health. He says some people abuse anxiolytics and are eager to be transferred to other hospital services. Many have temporary youth: “As soon as you can, you run away,” says one.

Despite everything, they treat patients with respect and affection. “Do you want to go? When she’s better! Let’s wear this mask to breathe better, okay?”

At 7:00 pm, Estrella’s husband infiltrates the corridors of the restricted area and tries to enter the room where his wife is. They have not seen him since he entered the emergency room at 2:30 p.m. A guard told her: “It’s closed, dear. You will have to wait in the waiting room.” The worker leaves to continue her work and he refuses to listen to her. He wants to meet his wife no matter what.

A man who has just lost his mother passes by and is making funeral arrangements on the phone. “Now it turns out that there is no room in the M-30 funeral home, which is the best fit for us,” he tells a health worker who asks him how he is.

The worker addresses Estrella’s husband, who is still waiting for someone to see him before entering the room.

-You cannot pass, gentleman. They will call you over the public address system. When it is possible to pass they will say ‘the relative in the room can now pass’, but come on, I don’t know if they will say it at some point or not.

-so?

“Okay, because I have already explained to you that the room has collapsed. If we admit one family member per patient, you cannot work.

“I don’t know what he’s like.” What I want is for you to do something fun and act blind.

-He?

-Let’s pretend you’re blind.

-can’t. If you come inside, you will be angry at me.

Estrella’s husband gave up. “Oh my God,” he says, putting his head down and returning to the waiting room, which is a cluster of coughing patients, whose faces look as if they’ve spent a vacation ruined by illness.

Do you have more information? Write to the author here fpeinado@elpais.es one of two fernandopeinado@protonmail.com

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