Marion is a 28-year-old junior doctor in an adult psychiatric care unit at a hospital in the town of Reims, in the Champagne region, about 150 kilometres east of Paris. The unit, one of several managed by the EPSM, (for “l’établissement public de santé mentale de la Marne”) is home to about 20 patients who have all been subject to the restrictions introduced across France by the lockdown on public movement that began on March 17th.
“Cigarettes are a key issue,” she said. “For some patients, smoking their cigarette is the day’s only pleasure.” Last Friday, she went out to buy several packs. “I never thought that one day I’d go and buy cigarettes for my patients! But it is difficult to get them to respect the confinement.”
The national lockdown bans all but essential movement, which for the wider public is limited to travelling to places of work (when their jobs cannot be done from home), to buy food (and tobacco), to get to a medical appointment or a family emergency, and brief daily exercise. For Marion’s patients, the isolation is particularly affecting. “Normally, we try to open up the service as much as possible. Social interaction is part of the care, and it also allows us to evaluate the progress of a patient. We lock the rooms so that they return to them as little as possible. Now, it’s the opposite.”
“Our idea is to avoid letting the wolf into the manger, that the coronavirus doesn’t come here. We already know that, in general, patients with psychiatric pathologies are not the priority for physical care. It’s even worse in the context of Covid-19. We were conscious of that danger from the beginning [of the virus epidemic] because a night nurse had symptoms of the coronavirus. Other care workers got it afterwards. They are all off work. We’re very careful.”
“At the moment the service lacks a little life. Normally, the patients discuss amongst themselves, call upon the staff. They don’t have television in their rooms so that they don’t close in on themselves. The meals are had in a common room, all together. But now, each keep to their rooms, they eat in their bed from a tray. We negotiated for them to be able to visit the television room, placing sufficient distance between them. Nurses also continue to carry out aesthetic care, manicures or [hair] colouring. It’s a good middle road, it works well. It took a week all the same for them [the management] to say ‘OK’.”
Enlargement : Illustration 1
“The guardians don’t come any more, and the contact with families is also reduced. For some patients the families are allowed to come, keeping to two metres from the front door. Some [patients] are very isolated whereas before their family members came every day.”
“With the halt to visits, we also look for solutions to have clean clothes. The auxiliary nurses are full of ideas for solutions, so it’s OK. We’re a super team, watching out for the every needs of our patients.”
“We’re afraid of making them more dependent than they already are. We don’t want to ‘psychiatrise’ them, but the regulations slow us down. For example, in the closed unit, where we have isolation rooms, a new patient was placed in 14 days’ confinement like all those who arrive at the hospital. Usually, the idea is to open up the room more and more, to accompany the patient and to allow us to see if things are getting better. Now it’s complicated to organise the opening up because they mustn’t come across other patients during the 14-day confinement.”
“We were also given the order, on the Monday at the beginning of the [national] lockdown, to let out the maximum possible number of patients. The aim was to free up the most space possible, knowing that we have double rooms. Usually we take the time to establish links, to prepare a departure. There it was a catastrophe. I organised the departure of patients who I wasn’t necessarily in agreement with [allowing them to leave] because they were too fragile or had a family entourage that didn’t sufficiently hold together. There were six or seven who left, most of whom have returned. For some, it was virtually certain. They came back spontaneously, saying ‘Things aren’t going at all right’. There was one patient who was certain that the virus was everywhere, and that his water was contaminated. Others were very depressed and made anxious by the confinement. We, ourselves, find it difficult to put up with, and for them it’s even worse. It’s also difficult for family members.”
“There was one who had an appointment at the medical-psychological centre one week later. He didn’t get to it. We don’t know where he is or if he’s following his medication. In normal times, we would have prepared his outing better. We had prepared for a more substantial process by bringing the CMP teams over here, and to organise interviews with the family. Here we didn’t do so. We lost him. He’ll come back, but it’s a pity.”
“We’re not terribly well equipped. In psychiatry, one is never served first. In the beginning we didn’t have masks, and the teams weren’t at their best. Afterwards, we had one mask per person per day. If we were on a 24-hour shift we kept the same mask. Since Friday, we have the right to two masks. We didn’t have any more hand sanitizer gel – afterwards we had some from time to time. We don’t really know when, we get vague replies, it’s quite unsettling.”
“Like other specialised units, we’re just ticking over. People don’t come. But we know that those who are anxious, who need to be cared for, they will arrive one day. At a given moment there’ll be a blockage, and things won’t be simple. I don’t know if this is being planned for, we have no information about this. We’re rather given the message that we’re [now just] managing the moment and we’ll see later, that the hospital will adapt.”
“We know that there is going to be a rebound effect. With the limitation on consultations, we’re going to have a boomerang return. I’m worried for my patients, those who were doing well. I’m afraid that they collapse. We’re waiting. I’m an optimist by character, so I tell myself we’ll see what happens and we’ll deal with one patient after another.”
“Our patients need to take fresh air. Here we have a small patio in the middle where they can go in turn. It’s almost prison-like. We proposed setting up cooking activities, with one nurse and one patient, but it was turned down. Things are quite tight. We don’t know too well where the blockage is when we put in requests. We’re always told that it’s complicated. Even when we asked for permission to accompany patients on a visit to the CHU [teaching hospital] hall. Some were used to going there everyday to have a coffee. Now, it’s not possible. I think that at some point there will be the need to adapt. For trips outside, we have to be able to, it’s not possible to keep going without. We’re always told that it’s complicated, so we try to nibble away, bit by bit. We succeeded in nibbling for the television room!”
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- This interview is one of a series of 15 with junior doctors in hospitals across France, entitled ‘Journal de bord des internes’ (“House doctors’ logs”) published in French by Mediapart since March 24th. The whole series can be found here, the original French version of this interview can be found here, and another from the series translated into English here.
English version by Graham Tearse