The cause of death in covid-19 patients is multifactorial; most die of acute respiratory failure secondary to extensive lung damage, but other causes such as multiple organ failure may also exist. Dr. César Luna, head of pathological anatomy of the National Institute of Respiratory Diseases (INER), explains the protocol that follows the declaration of death from covid-19.
“The first thing is to notify the pathology service, who are preparing to receive the body; nurses come to the patient’s bed to cover the body, consisting of sealing the nose and mouth with cotton and wrapping them in a sheet ”.
“Then the orderlies come in and help to place the body in a hermetically sealed mortuary bag; at the same time, the death note is made that includes the causes of death, it also includes a document with the pre-mortem events ”.
“By routes previously drawn, the orderlies take the body to the pathology area. All mentioned personnel are covered with their proper protective equipment. It is received by technicians, who pass them to other stretchers or refrigerated drawers, especially if their relatives are going to take time to collect them.
At this point, family members are asked for permission to do a necropsy. Of 549 deaths registered in the INER, 46 autopsies have been authorized.
“Family members understand the importance of carrying out a post-mortem study and above all the value of starting something positive from such a tragic event, that is, their relative passed away, unfortunately, but even after death they can still contribute something valuable that allows us to know better this disease, ”explains Luna.
“We allow family members to stay up to 10 minutes, because depending on their different beliefs and ideologies, many choose to talk with their deceased, others pray, others, as is understood, are very devastated and are crying and part of the instinctive reaction Of the human being, at times, it is to jump or pounce on the body of your loved one, wanting to touch him, wanting to hug him, even kiss him; we have an acrylic capsule that has allowed us to contain family members ”.
To have the certainty that the body given is, in fact, the patient of the family; generates tranquility in the bereaved.
“We must also have that humane treatment and above all consideration for the relatives of the patients who died and in talks also with psychology and psychiatry we agree that this generates a pathological grief, that is, it will be more difficult to cope with the death of a loved one as it happens, for example, in an accident or in this case that it is a disease that had a long time to suffer, but suddenly we can no longer see it ”.
Only one person per family can pass the ID. In the framework of the Day of the Dead, Dr. Luna concludes by recalling one of the anecdotes that have remained in the months of the pandemic.
“The cultural issue is very important, to authorize an autopsy it was done by one of the patient’s relatives, but in accordance with his beliefs, he wrote a note and a sentence that asked us to read the body of his relative before conducting the study , which we respect, the team read as is, of course we respect the will to be able to carry out this study and, above all, respect their beliefs ”.
Until the last breath
“I watched her oxygen saturation drop little by little. He gasped, strained for air. Don Jorge, approximately 70 years of age, diabetic, hypertensive and amputee with 3 limbs infected by the SARS-CoV-2 virus did not respond to treatment. When he saw his situation, he asked me not to intubate him, and he signed his letter of non-resuscitation with the only hand he had.
Alma Edith Benítez, head of the nursing service of sector 4-2 of the National Medical Center 20 de Noviembre del ISSSTE, accompanied Don Jorge, until his last breath.
“It was very depressing and I felt very helpless. What we did, all the nursing staff, was we took turns so that he did not die alone, and while this was happening we caressed him, we took his little hand, we prayed, we told him to close his eyes and follow that light that would take him where he no longer went to suffer more, ”Benítez asserted.
In 25 years of service, Chief Alma had never faced such a dimension of death.
“Right now we are against death constantly, every day and at all hours; the truth is a very bitter experience. These patients collapse in minutes and the nursing and medical staff are the last to see them, to fire them “
“We are going through a very difficult time where a patient who is admitted, in fact, almost always asks us what will happen to me? Am I going to die? It is very sad to see how entire infected families enter, families from which father dies, mother dies and leaves children orphans “
For the nurse, there is no doubt that the best treatment that can exist for covid patients is support, affection and solidarity.
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