KAWASAKI, Japan (Reuters) – Two medics with Tokyo license plates jump out of the back of an idle ambulance and carefully lower an elderly woman onto a stretcher. The patient, whose little face is covered with an oxygen mask, disappears behind the automatic doors of St. Marianna.
A health care professional wearing personal protective equipment (PSA) works in the intensive care unit (ICU) for patients with coronavirus disease (COVID-19) at St. Marianna Medical University Hospital in Kawasaki, south of Tokyo, Japan. May 4, 2020. REUTERS / Issei Kato
Another suspected COVID-19 patient has arrived.
In the midst of a global pandemic, St. Marianna University Hospital, a Catholic facility in a suburb of the working class south of Tokyo, has become synonymous with the virus.
In the three months since the first wave of sick passengers from the cruise ship Diamond Princess arrived, the hospital has treated around 40 seriously ill people, more than almost any other medical facility in Japan. It even took in patients when other hospitals rejected them.
Doctors intubated patients in a tent set up in the parking lot and performed tracheotomies in a Saran-wrapped operating room. Nurses in full protective gear gather in groups of six to move patients associated with a tangle of life-saving machines. And in the staff room there is an illustration of “Amabie”, a mythical Japanese creature that is supposed to protect against epidemics.
By most standards, Japan has weathered the global pandemic better than many other countries. Infections have not increased here like in other countries, and new cases have slowed since mid-April. To date, Japan has confirmed 16,251 infections and 777 people have died in more than 300,000 deaths worldwide.
In St. Marianna, where each hall and room in the emergency and intensive care center has been assigned one of three colors: green, yellow and red. Daily life now revolves around these limits. Nurses and doctors move between the world of waiting relatives, who wear surgical masks in the "green" zone, to the "red" station, where they dress like astronauts, wear heavy Tyveks and HALO respirators.
Yasuhiko Taira, a professor at the medical school here, said when the first COVID-19 patients arrived in February, he reminded employees that they were required to take in coronavirus patients who couldn't go anywhere else.
"We told them yes, there is a high possibility that you will get the virus, and since we are doctors, there is not much we can do about it," said Taira, 66, who previously headed the intensive care unit. "If we run away, who will?"
When St. Marianna was overwhelmed with patients at the beginning of the crisis, some private and public hospitals refused patients for a number of reasons, including lack of specialized staff and protective equipment, with intensive care units frequently citing capacity constraints.
In April, Japan doubled the funds hospitals receive to take critical COVID-19 patients and relieved places like St. Marianna.
During the multi-day stay with "Team C", a group that is responsible for the care of coronavirus patients in the intensive care unit in St. Marianna, the employees feel a sense of resignation about what awaits them and what will happen in the coming months caring for the patient who may seem on the verge of recovery just to escape a few days later.
"The stress is starting to pile up"
It is 8:00 a.m. and night shift doctors come to a senior physician on duty and read a series of numbers and acronyms that describe the different conditions of each of the 11 patients in the intensive care unit. Shigeki Fujitani walks down a narrow corridor towards the central nursing station, grabs a worn cell phone and nods at the employees in blue and purple peels.
"We had a death this morning," says Fujitani, the 54-year-old director of the intensive care unit, and walks up to a large whiteboard that is taped into a grid. The names of critical patients, all men in their fifties and sixties, are listed to the left of a short story of their time on the ward.
The dead man's name has already been removed from the table. The three beds that are now available in the intensive care unit are expected to be filled by evening.
"It is common for nothing to change for weeks and then the patient does not make it," says Fujitani later, walking up and down in his office.
He mentions an intensive care doctor who died of suicide in New York after seeing dozens of coronavirus patients die in their hospital.
"Everyone tries to cure the patient and if you can't … the stress increases after two or three months," he says.
"YOU CAN'T SEE THE END OF THIS"
Naoya Kohamoto takes a deep breath in front of the sliding doors of the intensive care unit.
"You can't see the end," says Kohamoto, 37, a nurse who joined the coronavirus team a month ago. "You just don't get any better. You see data that says 80 percent of intubated patients can't, but you always hope your patient doesn't."
When doctors in the intensive care unit sense that a patient is approaching death, Kohamoto calls the patient's family and asks them to come to the hospital. Although they cannot be physically close to their sick relative, they can talk to them through Facetime.
Kohamoto wears two layers of gloves, a face mask, a respirator, and several plastic clothes and holds an iPad to the unconscious patient so family members can share memories and say goodbye.
"I tell them that their father is doing everything he can to get home," he says. When a patient dies, Kohamoto holds the iPad to the doctor who issues the official death certificate.
On a nearby billboard, next to a handwritten letter from a family member of a patient who died last month, is a clear file with informed consent for the experimental drug Avigan.
"I never thought that something terrible could happen, and I still can't believe it's true," wrote the sender. "For all of you who have worked at risk of infection, with your own fear and worry, our entire extended family would like to express our thanks for everything you have done."
Kohamoto holds his pill against his chest. After a pause, he puts on his glasses and returns to the intensive care unit through the automatic doors.
"A long battle"
With governments considering reopening their economies after months of blocking and people hoping to go back to their normal routines, even frontline medical professionals are unclear as to how reopening can lead to new infection spikes.
"What we are preparing now is months of it, a break, then a small gathering or tip," says Fujitani. "It's going to be a long struggle and we can't let employees, especially nurses, burn out."
Intensive care specialist Yasunobu Tsuda, whose wife is preparing to work as a midwife in St. Marianna again after maternity leave, says the work is taking its toll.
"You go home and the first thing you want to do is hug your child at the door, but you can't," he says. Tsuda also wears a mask at home.
"I don't think my child still knows my face."
Reporting by Mari Saito; Edited by Kari Howard
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