Mathieu is an “interne”, a junior doctor, in intensive care medicine at a teaching hospital in Strasbourg, the capital of the Alsace region in north-east France. He is one of around 30,000 ‘intern’ medics of all types in the country, who are full-time medical staff gaining clinical experience after their studies and who work in semi-autonomy under the authority of a senior doctor.
The 26-year-old has been plunged into the frontline of the Covid-19 epidemic, working in one of the French regions worst-hit by the extraordinary health crisis and where, as of mid-March, hospitals became overwhelmed by the avalanche of patients infected by the virus.
Mediapart spoke to him by phone on Friday, as he walked through the streets of Strasbourg, largely empty because of the national lockdown on public movement, but bathed in sunshine. “Normally, I take the tram home from work, but here I’m going back on foot, a 25-minute walk,” he said. “The weather’s really nice, the trees are flowering. The air is good. When you’re inside, there’re no windows, or almost none. In the patients’ box it’s a pretty sombre universe. I would never have thought that the journey from work could be the most enjoyable of my day.”
Mathieu had just finished his duty shift. “What time is it? 11.30am? So, I’ve worked 26 hours on the trot. That’s my fifth duty period in ten days, which represents a total of about 110 hours. I’m a bit beat. We don’t sleep, we’re always on our guard, all the time concentrated. You have to meet the situation psychologically and physically.”
After an intense period through March, the workload picked up further over the recent days in the intensive care unit of his hospital, the CHU de Strasbourg. “In April, another duty line was added so that we number two interns at the same time [editor’s note: instead of the previous one intern on call]. It’s indispensable for us to be able to look after Covid patients at the same time, who can have acute complications and who require constant supervision, but also so that we can rapidly intervene on the usual pathologies that arrive at the hospital – if, for example, an intern is needed for the emergency room for vital urgencies like cerebral haemorrhages.”
“There are seven of us as interns, and by doubling the duty periods means that each of us does a duty period [of 24 hours on call] about every three days. We try to take it upon ourselves and to self-manage but if we have to continue doubling the duty periods in May that’s going to be a lot.”
The other pathologies are coming back to the hospital because we’re reprogramming surgery, or because there were patients who were probably redirected to other departments. There has also been an impact from the lockdown on the drop in multiple traumas, for example with the fewer road accidents or people who fall off a roof while working.”
“Life will return to the rest of the hospital, patients will come back to the recovery room after the operations, and to intensive care. We have less pressure with the arrivals in intensive care, we get fewer calls from outside. Even if there are still a very large majority of Covid patients, and little space for the others. The intensive care is divided into two sectors. There was a period when we were at 100 percent of Covid patients, with just one box free in case, for example, there was a major road accident, because we’re a centre of reference for multiple traumas.”
As of now we have three or four patients who are not Covid. They are in care for cerebral haemorrhages or trauma. We’re not yet at the point of telling ourselves ‘We’ll set up a Covid sector and a non-Covid sector.”
“We feel we’re in an uncertain phase. We don’t yet know whether there’ll be a rebound [a second wave of Covid-19 virus infections] effect, that’s what scares me the most. It’s said that there are fewer admissions into intensive care – well, yes, because there are no more places. I remain very cautious and modest about the possible evolution of the situation. If there is a rebound when the life at the hospital returns a little [to normal], I don’t know how we’ll handle things.”
“There’s talk of a transition phase but, in my opinion, caution is required. One must be lucid. A plateau phase means that for one patient who leaves, there’s another who arrives. In intensive care, we still have all cases, including early stage Covid. We mustn’t find ourselves with our backs to the wall if there’s a new stage of contamination at the moment the lockdown is lifted. I’m afraid that we put all that behind us a little too soon. We have no treatment, no serology tests, we really must be very careful.”
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We too are impatient to go and see our friends, our families, to go and have drinks outside. We suffer from the lockdown enormously. We ‘eat’ Covid, we ‘live’ Covid, we ‘walk’ Covid. We’ve had our fill of it. But we are also very worried about the lifting of the lockdown.
“Despite the fatigue, I find it difficult to sleep. When I get home, I collapse, but I wake up a few hours later telling myself ‘Shit, did I forget to do that?’. We sleep Covid too. In normal times, I can lie in right up to 4pm. Here, I’ll sleep four or five hours.”
“This morning, at the end of the duty period, we discovered in the press the account of one of our patients who was transferred [to another region] and who has left hospital. He is alive. We didn’t know, and we were really so happy. There was also a lady who came to pick up the belongings of another patient who I had looked after and who was also transferred. I expected the worse when I saw her arrive. Then, she told me ‘He’s come back home, he’s doing fine’. It’s incredible to hear that when you’re exhausted and fed up. We’re extremely satisfied about all the work that we had been able to provide. We’re managing an important job, that’s gratifying. When we leave, we still have a little degree of adrenalin before collapsing.”
I’m firstly going to stop off to do some shopping near my home because I’m hungry and I’ve nothing more to eat. I’m going to buy a can of ravioli, to cook in the microwave. I like food but I’m not difficult, I give priority to something simple, to make in less than 20 minutes. I take a nice beer at the same time. Even just one glass hits me at the moment, I have lost all tolerance. I go straight to sleep on the sofa.”
I moved into my apartment a short while ago. With my neighbours, we don’t know each other, we just give a ‘bonjour’ when we come across each other in the lift. I had a neighbour who was a bit noisy and I put a little note in the entrance, a very kind word and not at all aggressive, to say ‘Mercy, if you could stop, I work in intensive care, I have to sleep, I’m exhausted’. That prompted an impressive spring of solidarity from all the neighbours. I was left chocolates at Easter, I had a note offering to do my shopping. Also, I found a package in front of my door with chocolates and beers with a small word ‘Thank you, and all strength’.”
I hope people don’t forget us afterwards. It’s a year now that public hospital [staff] and interns are [demonstrating for improved conditions] in the street and we had the impression of not being heard. When you see today that Germany has double the intensive care beds and the personnel to with it…I’m at a level of Bac plus 8 [eight years of higher education studies after the baccalaureate school-leaving exam], I don’t count my hours, and I’m paid 1,450 euros per hour. In Germany, a medical intern gets 3,000 euros. A bonus payment has been announced, that’s a good thing, but it’s a revalorisation that is needed. I think about my nursing colleagues also, who are amazing. They’re at the end of their tethers but they are admirable.”
Since November I’ve put in for two days of leave. I hope to be able to put in for leave in June, perhaps, to be able to sleep a little bit.”
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- This interview is one of a series with healthcare staff in hospitals across France, entitled ‘Journal de bord des internes’ (“House doctors’ logs”) regularly published in French by Mediapart since March 24th. The whole series can be found here, and the original French version of this interview can be found here.
English version by Graham Tearse